Impact directly over the cardiac silhouette is necessary to produce ventricular fibrillation in an experimental model of commotio cordis

被引:97
作者
Link, MS
Maron, BJ
VanderBrink, BA
Takeuchi, M
Pandian, NG
Wang, PJ
Estes, NAM
机构
[1] Tufts Univ, Sch Med,New England Med Ctr, Ctr Cardiovasc Evaluat Athletes, Cardiac Arrhythemia Ctr, Boston, MA 02111 USA
[2] Minneapolis Heart Inst Fdn, Cardiovasc Res Div, Minneapolis, MN USA
关键词
D O I
10.1016/S0735-1097(00)01142-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES In an experimental model of sudden death from chest wall impact (commotio cordis), we sought to define the chest wall areas important in the initiation of ventricular fibrillation (VF). BACKGROUND Sudden death can result from an innocent chest blow by a baseball or other projectile. Observations in humans suggest that these lethal blows occur over the precordium. However, the precise location of impact relative to the risk of sudden death is unknown. METHODS Fifteen swine received 178 chest impacts with a regulation baseball delivered at 30 mph at three sites over the cardiac silhouette (i.e., directly over the center, base or apex of the left ventricle [LV]) and four noncardiac sites on the left and right chest wall. Chest blows were gated to the vulnerable portion of the cardiac cycle for the induction of VF. RESULTS Only chest impacts directly over the heart triggered VF (12 of 78: 15% vs. 0 of 100 for noncardiac sites: p < 0.0001). Blows over the center of the heart (7 of 23; 30%) were more likely to initiate VF than impacts at other precordial sites (5 of 55; 9%, p = 0.02). Peak LV pressures generated instantaneously by the chest impact were directly related to the risk of VF (p < 0.0006). CONCLUSIONS For nonpenetrating, low-energy chest blows to cause sudden death, impact must occur directly over the heart. Initiation of VF may be mediated by an abrupt and substantial increase in intracardiac pressure. Prevention of sudden death from chest blows during sports requires that protective equipment be designed to cover all portions of the chest wall that overlie the heart, even during body movements and positional changes that may occur with athletic activities. (C) 2001 by the American College of Cardiology.
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页码:649 / 654
页数:6
相关论文
共 27 条
[1]   COMMOTIO CORDIS - THE SINGLE, MOST COMMON CAUSE OF TRAUMATIC DEATH IN YOUTH BASEBALL [J].
ABRUNZO, TJ .
AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1991, 145 (11) :1279-1282
[2]  
Adler P, 1996, YOUTH BASEBALL PROTE, P1
[3]   SWINE AS AN INVIVO MODEL FOR ELECTROPHYSIOLOGIC EVALUATION OF CARDIAC PACING PARAMETERS [J].
BOWMAN, TA ;
HUGHES, HC .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1984, 7 (02) :187-194
[4]   Sudden death of a young hockey player: Case report of commotio cordis [J].
Deady, B ;
Innes, G .
JOURNAL OF EMERGENCY MEDICINE, 1999, 17 (03) :459-462
[5]  
Dickman Gerald L, 1978, Phys Sportsmed, V6, P85, DOI 10.1080/00913847.1978.11948393
[6]   ELECTROPHYSIOLOGICAL EFFECTS OF MYOCARDIAL STRETCH AND MECHANICAL DETERMINANTS OF STRETCH-ACTIVATED ARRHYTHMIAS [J].
FRANZ, MR ;
CIMA, R ;
WANG, D ;
PROFITT, D ;
KURZ, R .
CIRCULATION, 1992, 86 (03) :968-978
[7]   STREPTOMYCIN REVERSES A LARGE STRETCH-INDUCED INCREASE IN [CA2+](I) IN ISOLATED GUINEA-PIG VENTRICULAR MYOCYTES [J].
GANNIER, F ;
WHITE, E ;
LACAMPAGNE, A ;
GARNIER, D ;
LEGUENNEC, JY .
CARDIOVASCULAR RESEARCH, 1994, 28 (08) :1193-1198
[8]   Stretch-activated ion channels in the heart [J].
Hu, H ;
Sachs, F .
JOURNAL OF MOLECULAR AND CELLULAR CARDIOLOGY, 1997, 29 (06) :1511-1523
[9]  
HUGHES HC, 1986, LAB ANIM SCI, V36, P348
[10]   COMMOTIO-CORDIS IN 2 AMATEUR ICE HOCKEY PLAYERS DESPITE THE USE OF COMMERCIAL CHEST PROTECTORS - CASE-REPORTS [J].
KAPLAN, JA ;
KAROFSKY, PS ;
VOLTURO, GA .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1993, 34 (01) :151-153