Commotio Cordis in Sudden Cardiac Death in the Young: A State-of-the-Art Review

Abstract

Commotio cordis is a rare but fatal cause of sudden cardiac death in young people, particularly athletes exposed to non-penetrating chest trauma. Commotio cordis occurs when an impact to the chest triggers a lethal ventricular arrhythmia in the absence of pre-existing structural heart disease. Despite advances in the understanding of commotio cordis, the prevention and management of this condition remain challenging. The literature indicates that commotio cordis is most common in adolescents and sports such as baseball, football, and ice hockey. The key pathogenic mechanism involves a chest impact occurring during a vulnerable phase of the cardiac cycle, leading to ventricular fibrillation. Immediate cardiopulmonary resuscitation and prompt use of an automated external defibrillator are crucial for survival. However, the effectiveness of preventive measures, such as chest protectors and greater awareness of cardiovascular emergencies, remains debated. As a leading cause of sudden death in young athletes, commotio cordis requires further research to refine prevention strategies and improve outcomes. This review provides an updated overview of the pathophysiological mechanisms, risk factors, intervention strategies, and preventive approaches for this condition.

Keywords: autopsy pathology; commotio cordis; sudden cardiac death; young.