Commotio cordis in athletes

Commotio cordis is one of the leading causes of sudden cardiac death in young athletes. In commotio cordis, blunt, non-penetrating chest trauma triggers ventricular fibrillation that leads to sudden cardiac death. Victims are predominantly young adolescent males involved in sports. In order to induce sudden cardiac death, the blow must be delivered in a narrow 20 msec window during cardiac repolarization. Additional factors such as location of the impact, velocity, shape, and firmness of the object alter the probability of inducing ventricular fibrillation. On a cellular level, the chest wall impact during a vulnerable time window triggers activation of a mechanosensitive K_ATP⁺ channel and leads to inhomogeneous depolarization, thereby creating an arrhythmogenic substrate. Treatment involves timely delivery of high-quality cardiopulmonary resuscitation. The outcome of resuscitation in commotio cordis is similar to other forms of sudden cardiac death, with better results seen in early use of a defibrillator (within 3 minutes) after the event. Commercially available chest barriers have not shown to be effective in preventing commotio cordis. A biomechanical surrogate is now available to access the ability of chest wall protectors to lower the risk of commotio cordis.