From Innocuous Contact to Sudden Death in Sports: An Overview of Commotio Cordis

Abstract

Commotio Cordis (CC) is a rare but potentially fatal condition that occurs when a blunt impact to the chest causes ventricular fibrillation (VF) and sudden cardiac death. CC is most common in teenage males who participate in sports, but it can occur in people of all ages. The mechanical distortion of the myocardium caused by trauma can lead to inappropriate depolarization and myocardial firing, which can cause arrhythmias. Immediate identification and defibrillation are crucial to reducing mortality rates. Currently available screening tools for CC, such as the electrocardiogram (EKG), stress EKG, or echocardiogram, lack sensitivity for primary prevention. The pathogenesis of CC is influenced by a variety of factors, including the location, velocity, shape, and hardness of the impact object, as well as biological characteristics like gender, chest wall flexibility, and genetic susceptibility. The ion channels involved in arrhythmia generation in CC are thought to be stretch-activated channels (SACs). Diagnosis is based on a history of chest wall blunt trauma, and treatment includes immediate supportive care and defibrillation according to BLS and ACLS protocols. The currently available chest wall protectors have not been shown to prevent CC, and improving sports equipment may help reduce the incidence of CC. A famous American football player incident in which he collapsed after making a tackle during the first quarter of the Bills' game against the Cincinnati Bengals on January 2, 2023, is a notable case of commotio cordis (CC) in a football player. This incident is unusual because helmets are not typically associated with CC, which is usually caused by external blunt force trauma to the chest with small balls, hockey pucks, or even a blow. The player, who fortunately survived the event, was relatively older than the recorded mean age for CC and has a more rigid chest wall. It is unclear whether this case is an exception or if helmets can pose a risk for CC in certain circumstances. The case highlights the need for continued research and awareness of CC to improve prevention and management strategies for sudden cardiac arrest in sports. Despite being an ancient condition, CC remains a tragic event, and further research is needed to improve preventive measures and reduce mortality rates.