Commotio Cordis Is Real and Awareness Can Save Lives, Experts Say

A new case report(opens in new tab/window) appearing in Heart Rhythm Case Reports(opens in new tab/window), an official journal of the Heart Rhythm Society, published by Elsevier, details the commotio cordis event experienced by a Romanian basketball player that resulted in cardiac arrest. The case is unique because it is validated and documented by an ECG and video evidence(opens in new tab/window) of the event. Swift action by onlookers saved his life.

In early January 2023, commotio cordis received substantial visibility and notoriety as the underlying cause of cardiac arrest when Damar Hamlin, a defensive player for the Buffalo Bills, was struck in the chest during a collision with an opponent in a US NFL professional football game. Rapid cardiopulmonary resuscitation (CPR) and defibrillation were life saving, with the event witnessed by millions on television in real time.

In Bucharest, Romania, 60 days later and 5,000 miles away, another commotio cordis event occurred, this time during a youth basketball tournament game witnessed only by families and friends. An 18-year-old basketball player (M.V.) was hit in the chest by an inadvertent light blow from an opponent’s elbow and collapsed during the game, which was filmed and documented. Rapid CPR and one defibrillation shock saved his life.

Commotio cordis events have been reported globally in more than 20 countries, but are extraordinarily rare and virtually always counterintuitive, as in M.V.’s case. In commotio cordis, ventricular fibrillation is precipitated by a blow over the heart and requires a precise timing to a narrow 20 ms window at the upstroke of the T wave.

After the commotio cordis event, M.V. was examined at Lahey Hospital and Medical Center in Burlington, MA, USA, by a team led by Barry J. Maron, MD.

Dr. Maron explains, "There is some skepticism regarding the existence of commotio cordis. Since the case of the Romanian basketball player was recorded and documented, it validates the existence of commotio cordis. It is a real phenomenon, and it occurs in real people in sports and in daily living. It is important to raise awareness of this condition, which is reversible with prompt intervention, as this case demonstrates.”

Prior to the event, M.V. was completely healthy without cardiovascular complaints; there is no family history of cardiovascular disease. When evaluated at Lahey Hospital and Medical Center six weeks after his cardiac arrest, he was asymptomatic and neurologically intact, without residual medical problems, and had begun to resume normal daily activities without difficulty.

The commotio cordis event reported here is notable for expanding the clinical spectrum of commotio cordis, given that competitive basketball previously had not been associated with this cause of cardiac arrest. Contact sports such as baseball/softball and hockey have dominated commotio cordis, owing to the greater possibility of physical contact and chest blows from hard-core projectiles (e.g., balls and pucks).

Dr. Maron concludes, [i"In this report, we have underscored once again that commotio cordis can occur under virtually any circumstance where there is the possibility of physical bodily contact of any magnitude, or projectile-induced chest blows, but always when least expected. This may be the best documented case we have of commotio cordis, which should go a long way to dispel skepticism"[/i]

The article is “Commotio cordis…once again: Unusual occurrence in a noncontact sport,” by Barry J. Maron, MD, Ethan J. Rowin, MD, and Martin S. Maron, MD (https://doi.org/10.1016/j.hrcr.2023.10.013(opens in new tab/window)). It appears online in advance of Heart Rhythm Case Reports, volume 9, issue 12 (December 2023), published by Elsevier.

The article is openly available at https://www.heartrhythmcasereports.com/article/S2214-0271(23)00260-9/fulltext(opens in new tab/window).

The video is posted at https://www.heartrhythmcasereports.com/cms/10.1016/j.hrcr.2023.10.013/attachment/3924a0b8-88c5-489a-80a6-caaa44d460ec/mmc1.mp4(opens in new tab/window). It shows the commotio cordis event during a high school basketball game in Romania as seen from multiple angles. Initially, there is a scramble for a loose ball and player M.V. (large white arrow) is struck in the chest by the elbow of an opponent. M.V. stumbles but remains upright for a few seconds just prior to full collapse in cardiac arrest (Credit: Heart Rhythm Case Reports).

Full text of this study is also available to credentialed journalists upon request; contact Jane Grochowski at +1 406 542 8397 or hmsmedia@elsevier.com. Journalists who wish to interview the case report authors should contact Barry J. Maron, MD, at barrymaron1@gmail.com.

●Chest blow–induced ventricular tachycardia and cardiac arrest in the absence of underlying cardiac disease (commotio cordis) is an uncommon, but important cause of sudden death, often in young people.
●Commotio cordis occurs in athletes during competitive or recreational sports or is associated with routine everyday activities.
●Commotio cordis chest blows can be substantial or alternatively appear trivial and counterintuitive.
●Timely recognition of a commotio cordis event is paramount, as cardiac arrest is reversible with prompt cardiopulmonary resuscitation / defibrillation.
●Although incompletely understood, the mechanism of commotio cordis requires a precise timing of the blow over the heart to a narrow 20 ms window at the upstroke of the T wave.

Heart Rhythm Case Reports(opens in new tab/window) is an official Journal of the Heart Rhythm Society(opens in new tab/window). It is an open access companion journal to the respected Heart Rhythm(opens in new tab/window). It provides rapid online electronic publication of the most important current case reports, illustrations, and educational vignettes in the field of cardiac arrhythmias and electrophysiology. The Journal publishes case reports and series devoted to the diagnosis and treatment of heart rhythm disorders, as well as the electrophysiology of the heart and blood vessels. All articles are peer-reviewed. www.heartrhythmcasereports.com(opens in new tab/window)

The Heart Rhythm Society(opens in new tab/window) is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal healthcare policies and standards. The Heart Rhythm Society is the preeminent professional group representing more than 8,000 specialists in cardiac pacing and electrophysiology from 94 countries. www.HRSonline.org(opens in new tab/window)

As a global leader in information and analytics, Elsevier helps researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. We do this by facilitating insights and critical decision-making for customers across the global research and health ecosystems. In everything we publish, we uphold the highest standards of quality and integrity. We bring that same rigor to our information analytics solutions for researchers, academic leaders, funders, R&D-intensive corporations, doctors, and nurses.

Elsevier employs 9,000 people worldwide, including over 2,500 technologists. We have supported the work of our research and health partners for more than 140 years. Growing from our roots in publishing, we offer knowledge and valuable analytics that help our users make breakthroughs and drive societal progress. Digital solutions such as ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath support strategic research management, R&D performance, clinical decision support, medical education, and nursing education. Researchers and healthcare professionals rely on over 2,800 journals, including The Lancet(opens in new tab/window) and Cell(opens in new tab/window); 46,000+ eBook titles; and iconic reference works, such as Gray’s Anatomy. With the Elsevier Foundation(opens in new tab/window) and our external Inclusion & Diversity Advisory Board, we work in partnership with diverse stakeholders to advance inclusion and diversity in science, research and healthcare in developing countries and around the world. 

Elsevier is part of RELX(opens in new tab/window), a global provider of information-based analytics and decision tools for professional and business customers.