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. 2023 Aug;9(8 Pt 1):1321-1329.
doi: 10.1016/j.jacep.2023.01.010. Epub 2023 Mar 22.

Commotio Cordis in Non-Sport-Related Events: A Systematic Review

Rafael N Lee  1 , Thalys Sampaio Rodrigues  2 , Joscelyn T Gan  1 , Hui-Chen Han  1 , Rama Mikhail  1 , Prashanthan Sanders  3 , Omar Farouque  1 , Han S Lim  4
Affiliations
Free article

Commotio Cordis in Non-Sport-Related Events: A Systematic Review

Rafael N Lee et al. JACC Clin Electrophysiol. 2023 Aug.
Free article

Abstract

Background: Commotio cordis is an increasingly recognized cause of sudden cardiac death. Although commonly linked with athletes, many events occur in non-sport-related settings.

Objectives: The goal of this study was to characterize and compare non-sport-related vs sport-related commotio cordis.

Methods: PubMed and Embase were searched for all cases of commotio cordis from inception to January 5, 2022.

Results: Of 334 commotio cordis cases identified, 121 (36%) occurred in non-sport-related contexts, which included assault (76%), motor vehicle accidents (7%), and daily activities (16%). Projectiles were implicated significantly less in non-sport-related events (5% vs 94%, respectively; P < 0.001). Nonprojectile etiologies in non-sport-related events mostly consisted of impacts with body parts (79%). Both categories affected similar younger aged demographic (P = 0.10). The proportion of female victims was significantly higher in non-sport-related events (13% vs 2%, respectively; P = 0.025). Mortality was significantly higher in non-sport-related events (88% vs 66%, respectively; P < 0.001). In non-sport-related events, rates of cardiopulmonary resuscitation (27% vs 97%, respectively; P < 0.001) and defibrillation (17% vs 81%, respectively; P < 0.001) were both lower and resuscitation was more commonly delayed beyond 3 min (80% vs 5%, respectively; P < 0.001).

Conclusions: Commotio cordis occurs across a spectrum of non-sport-related settings including assault, motor vehicle accidents, and daily activities. Both categories affected a younger and male-predominant demographic. Mortality is higher in non-sport-related commotio cordis, likely owing to lower rates of cardiopulmonary resuscitation, defibrillation, automated external defibrillator availability, and extended time to resuscitation. Increased awareness of non-sport-related commotio cordis is essential to develop a means of prevention and mortality reduction, with earlier recognition and prompt resuscitation measures.

Keywords: commotio cordis; defibrillation; sudden cardiac death; ventricular fibrillation.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Sanders has received lecture and/or consulting fees from Biosense-Webster, Medtronic, St Jude Medical (now Abbott), and Boston Scientific. Dr Sanders has received research funding from Medtronic, St Jude Medical (now Abbott), Boston Scientific, Biotronik, and Sorin. Dr Lim has received research support from St Jude Medical (now Abbott) and Medtronic. Dr Sanders has served on the medical advisory board of Biosense-Webster, Medtronic, CathRx, and St Jude Medical (now Abbott) and Pacemate. Dr Sanders reports that the University of Adelaide has received on his behalf research funding from Medtronic, Abbott Medical, Boston-Scientific, Pacemate and Becton Dickinson. Dr Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

  • Yes, Commotio Cordis Does Occur Outside of Sports.
    Rosenblatt AG, Link MS. Rosenblatt AG, et al. JACC Clin Electrophysiol. 2023 Aug;9(8 Pt 1):1330-1332. doi: 10.1016/j.jacep.2023.03.015. Epub 2023 May 24. JACC Clin Electrophysiol. 2023. PMID: 37227354 No abstract available.

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