Sudden Cardiac Death: An Update on Commotio Cordis

Sudden cardiac death (SCD) is one of the leading causes of cardiovascular mortality, and it is caused by a diverse array of conditions. Among these is commotio cordis, a relatively infrequent but still significant cause, often seen in young athletes involved in competitive or recreational sports. It is known to be caused by blunt trauma to the chest wall resulting in life-threatening arrhythmia (typically ventricular fibrillation). The current understanding pertains to blunt trauma to the precordium, with an outcome depending on factors such as the type of stimulus, the force of impact, the qualities of the projectile (shape, size, and density), the site of impact, and the timing of impact in relation to the cardiac cycle. In the management of commotio cordis, a history of preceding blunt chest trauma is usually encountered. Imaging is mostly unremarkable except for ECG, which may show malignant ventricular arrhythmias. Treatment is focused on emergent resuscitation with the advanced cardiac life support protocol algorithm, with extensive workup following the return of spontaneous circulation. In the absence of underlying cardiovascular pathologies, implantable cardiac defibrillator insertion is not beneficial, and patients can even resume physical activity if the workup is unremarkable. Proper follow-up is also key in the management and monitoring of re-entrant ventricular arrhythmias, which are amenable to ablative therapy. Prevention of this condition involves protecting the chest wall against blunt trauma, especially with the use of safety balls and chest protectors in certain high-risk sporting activities.  This study aims to elucidate the current epidemiology and clinical management of SCD with a particular focus on a rarely explored etiology, commotio cordis.