The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Mark S Link - One of the best experts on this subject based on the ideXlab platform.
-
don t forget Commotio Cordis
American Journal of Cardiology, 2021Co-Authors: Barry J Maron, Mark S LinkAbstract:Non-penetrating chest blows can occasionally trigger fatal ventricular tachyarrhythmias and sudden death (Commotio Cordis). Such events were initially reported in association with sporting activities and projectiles such as baseball/lacrosse balls. However, similar potentially fatal chest blows, seemingly incapable of causing death, can occur during a variety of other circumstances such as when delivered during a fight (by a fist) such as in the accompanying paper. Notably, Commotio Cordis events can be reversed by resuscitation and defibrillation.
-
Commotio Cordis in athletes
2021Co-Authors: Mohita Singh, Mark S LinkAbstract:Commotio Cordis is one of the leading causes of sudden cardiac death in young athletes. In Commotio Cordis, blunt, non-penetrating chest trauma triggers ventricular fibrillation that leads to sudden cardiac death. Victims are predominantly young adolescent males involved in sports. In order to induce sudden cardiac death, the blow must be delivered in a narrow 20 msec window during cardiac repolarization. Additional factors such as location of the impact, velocity, shape, and firmness of the object alter the probability of inducing ventricular fibrillation. On a cellular level, the chest wall impact during a vulnerable time window triggers activation of a mechanosensitive KATP+ channel and leads to inhomogeneous depolarization, thereby creating an arrhythmogenic substrate. Treatment involves timely delivery of high-quality cardiopulmonary resuscitation. The outcome of resuscitation in Commotio Cordis is similar to other forms of sudden cardiac death, with better results seen in early use of a defibrillator (within 3 minutes) after the event. Commercially available chest barriers have not shown to be effective in preventing Commotio Cordis. A biomechanical surrogate is now available to access the ability of chest wall protectors to lower the risk of Commotio Cordis.
-
abstract 10626 right atrial pressures compared to left ventricular pressures as predictors of ventricular fibrillation in Commotio Cordis
Circulation, 2018Co-Authors: Michael P Gannon, Mark S LinkAbstract:Introduction: Commotio Cordis is sudden cardiac death described in young athletes suffering blunt impact. Swine models have elucidated ventricular fibrillation (VF) from increased left ventricular ...
-
size as an important determinant of chest blow induced Commotio Cordis
Medicine and Science in Sports and Exercise, 2018Co-Authors: Christopher Madias, Barry J Maron, Cynthia Bir, Nathan Dau, N A Estes, Mark S LinkAbstract:PURPOSE Commotio Cordis is sudden cardiac death caused by a relatively innocent blow to the left chest wall. Adolescents account for the majority of the cases; whether this is due to the higher frequency of adolescents playing ball sports or whether there is some maturational reduction of risk is not known. METHODS In a swine model of Commotio Cordis, the effect of body weight/size (directly related to age) to the susceptibility of chest impact-induced ventricular fibrillation (VF) is examined. METHODS Ball impacts were delivered at escalating velocities from 48.3 to 96.9 km·h (30-60 mph) to 128 swine ranging in weight from 5 to 54 kg. RESULTS VF occurred in 29% of impacts to the smallest animals compared with 34% in the 14- to 239-kg group, 27% in the 24- to 33.9-kg group, 30% in 34- to 43-kg group, and 15% in the 44- to 54-kg animals. The highest-weight group was associated with a significantly lower incidence of VF compared with other weights (P = 0.002). In a multivariate logistic regression analysis, controlling for repeated measures, four variables predicted VF: body weight (P = 0.0008), velocity (P < 0.0001), distance from the center of the heart, (P < 0.0001), and peak left ventricular pressure induced by the blow (P = 0.0007). CONCLUSIONS In this experimental model, animals weighing <44 kg seem to have a similar susceptibility to Commotio Cordis, whereas animals weighing ≥44 kg have a lower susceptibility. An increase in size of the individual, rather than reduced play of ball sports, is the likely reason for the decreased Commotio Cordis incidence in older individuals.
-
development of a chest wall protector effective in preventing sudden cardiac death by chest wall impact Commotio Cordis
Clinical Journal of Sport Medicine, 2017Co-Authors: Kartik Kumar, N A Estes, Swati N Mandleywala, Michael P Gannon, Jonathan Weinstock, Mark S LinkAbstract:Objective Commotio Cordis, sudden death with chest impact, occurs clinically despite chest wall protectors worn in sports. In an experimental model of Commotio Cordis, commercially available chest wall protectors failed to prevent ventricular fibrillation (VF). The goal of the current investigation was to develop a chest wall protector effective in the prevention of Commotio Cordis. Design In the Tufts experimental model of Commotio Cordis the ability of chest protectors to prevent VF was assessed. Impacts were delivered with a 40-mph lacrosse ball, timed to the vulnerable period for VF. Intervention A chest wall protector or no chest wall protector (control) was randomly assigned to be placed over the chest. Four iterative series of 2 to 4 different chest wall material combinations were assessed. Materials included 3 different foams (Accelleron [Unequal Technologies, Glen Mills, PA], closed cell high density foam; Airilon [Unequal Technologies, Glen Mills, PA], closed cell low density soft foam; and an open cell memory foam) that were adhered to a layer of TriDur (Unequal Technologies, Glen Mills, PA), a flexible elastomeric coated aramid that was bonded to a semirigid polypropylene polymer (ImpacShield, Unequal Technologies, Glen Mills, PA). Main outcome measure Induction of VF by chest wall impact was the primary outcome. Results Of 80 impacts without chest protectors, 43 (54%) resulted in VF. Ventricular fibrillation with chest protectors ranged from a high of 60% to a low of 5%. Of 12 chest protectors assessed, only 3 significantly lowered the risk of VF compared with impacts without chest protectors. These 3 chest protectors were combinations of Accelleron, Airilon, TriDur, and ImpacShield of different thicknesses. Protection increased linearly with the thicker combinations. Conclusions Effective protection against VF with chest wall protection can be achieved in an experimental model of Commotio Cordis. Clinical relevance Chest protector designs incorporating these novel materials will likely be effective in the prevention of Commotio Cordis on the playing field.
N Mark A Estes - One of the best experts on this subject based on the ideXlab platform.
-
eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities task force 13 Commotio Cordis a scientific statement from the american heart association and american college of cardiology
Circulation, 2015Co-Authors: Mark S Link, N Mark A Estes, Barry J MaronAbstract:Commotio Cordis is defined as sudden cardiac death triggered by a relatively innocent blow to the precordium.1 Although initially thought to be extremely rare, it is now increasingly reported in the United States and worldwide.2,3 Enhanced recognition of Commotio Cordis, rather than an increase in event frequency, likely accounts for the greater visibility of those events. Commotio Cordis is one of the most common causes of sudden cardiac death in recreational and competitive sports, instantaneously resulting in a potentially fatal arrhythmia.4 Commotio Cordis is distinct from cardiac contusion, in which structural damage to the heart with resultant arrhythmias develops within 24 hours after severe chest impact.5 Risk factors for a Commotio Cordis have been defined by a Commotio Cordis Registry of clinical events and an experimental swine model. Human cases occur largely in adolescent males (95% of cases), with a mean age of 14 years.2 Impacts occur over the left chest wall and are generally sustained with a hard spherical object such as a baseball, hockey puck, lacrosse ball, or softball. Collapse is instantaneous or within a few seconds; when a defibrillator is used rapidly, the arrhythmia is typically ventricular fibrillation (VF). An experimental model of Commotio Cordis has confirmed the arrhythmia induced by a chest blow is VF.6 Impact must occur over the cardiac silhouette, and harder balls are more likely to induce VF.6–8 In addition, this model has demonstrated the critical importance of timing in that only those blows that occur during a narrow time segment of the T-wave upstroke reliably produce VF.6 These laboratory experiments have also shown the importance of size and shape of the object.9 Blows must occur directly perpendicular to the chest wall to produce VF, and impact velocities optimal to …
-
increasing survival rate from Commotio Cordis
Heart Rhythm, 2013Co-Authors: Barry J Maron, Tammy S Haas, Aneesha Ahluwalia, Ross Garberich, N Mark A Estes, Mark S LinkAbstract:Background Commotio Cordis events due to precordial blows triggering ventricular fibrillation are a cause of sudden death (SD) during sports and also daily activities. Despite the absence of structural cardiac abnormalities, these events have been considered predominantly fatal with low survival rates. Objective To determine whether expected mortality rates for Commotio Cordis have changed over time, associated with greater public visibility. Methods US Commotio Cordis Registry was accessed to tabulate frequency of reported SD or resuscitated cardiac arrest over 4 decades. Results At their Commotio Cordis event, 216 study patients were 0.2-51 years old (mean age 15±9 years); 95% were males. Death occurred in 156 individuals (72%), while the other 60 (28%) survived. Proportion of survivors increased steadily with concomitant decrease in fatal events. For the initial years (1970-1993), 6 of 59 cases survived (10%), while during 1994-2012, 54 of 157 (34%) survived (P = .001). The most recent 6 years, survival from Commotio Cordis was 31 of 53 (58%), with survivor and nonsurvivor curves ultimately crossing. Higher survival rates were associated with more prompt resuscitation (40% 3 minutes; P Conclusions Survival from Commotio Cordis has increased, likely owing to more rapid response times and access to defibrillation, as well as greater public awareness of this condition.
-
abstract 19706 increasing survival and decreasing sudden death rate from Commotio Cordis
Circulation, 2012Co-Authors: Barry J Maron, Tammy S Haas, Aneesha Ahluwalia, Ross Garberich, N Mark A Estes, Mark S LinkAbstract:Introduction. Commotio Cordis events due to precordial blows triggering ventricular fibrillation are a cause of sudden death (SD) in competitive and recreational sports and normal daily activities. Despite normal cardiac structure, these events have been considered predominantly fatal with survival rates of < 20%. Hypothesis. To determine whether there has been a change in the expected mortality rate for Commotio Cordis over time, associated with (or due to) greater public visibility of this condition. Methods. U.S. Commotio Cordis Registry was accessed to tabulate the frequency of resuscitated cardiac arrest or SD from 1970 to 2012. Results. At the time of their Commotio Cordis event, 215 study patients were 1 to 50 years old, mean 15; 95% were male. Death due to Commotio Cordis occurred in 156 individuals (73%), and the other 59 (27%) survived. Notably, the proportion of Commotio Cordis survivors increased steadily with a concomitant decrease in fatal events over 43 years: for the first 24 years (1970-1...
-
global epidemiology and demographics of Commotio Cordis
Heart Rhythm, 2011Co-Authors: Barry J Maron, Mark S Link, Tammy S Haas, Aneesha Ahluwalia, Christopher Semsarian, N Mark A EstesAbstract:Background The Commotio Cordis literature has largely focused on events occurring in the United States. However, with enhanced public awareness, Commotio Cordis has been increasingly recognized internationally as a cause of cardiac arrest and sudden death due to blunt nonpenetrating chest blows. Objective This study sought to characterize the demographics of Commotio Cordis globally in comparison to the U.S. experience. Methods This study used interrogation of the Commotio Cordis Registry (Minneapolis, Minnesota). Results We report 60 cases of Commotio Cordis occurring outside the United States from 19 countries (most commonly the United Kingdom and Canada) on 5 continents and compared these events to 2:3 occuring in the U.S. In the 2 groups, events were largely similar demographically, including frequency of survival (26% in U.S. vs 25%; P = .84), and the striking male predominance evident in both groups (i.e., 95%), although non-U.S. victims were somewhat older (19 ± 13 vs 15 ± 9; P = .002). Not unexpectedly, the groups differed with baseball/softball and football predominant in the United States (55% of events) and soccer, cricket, and hockey most common internationally (47% of events). Notably, the frequency with which soccer participation caused Commotio Cordis was much more common than expected, particularly in non-U.S. athletes (20% vs 3% U.S.; P Conclusion Commotio Cordis demonstrates a global occurrence, very similar demographically in the United States and internationally. However, the frequency with which chest blows from soccer balls caused Commotio Cordis events (particularly during sports played internationally) seems to contradict the prevailing notion that air-filled projectiles convey less risk for ventricular fibrillation than do those with solid cores (e.g., baseball or lacrosse balls).
-
golpe toracico Commotio Cordis y epidemiologia de la muerte subita en el lacrosse de competicion
Pediatrics, 2009Co-Authors: Barry J Maron, Tammy S Haas, N Mark A Estes, Joseph J Doerer, James S Hodges, Mark S LinkAbstract:Objetivo: Se esta prestando una atencion creciente a los riesgos en el campo de atletismo asociados a golpes toracicos contusos, no penetrantes (Commotio Cordis) pero la epidemiologia de estos acontecimientos es incompleta. Metodos: Evaluamos nuestro Sudden Death in Young Athletes Registry, 1980-2008, para definir un perfil clinico de las muertes subitas atribuidas a Commotio Cordis (y otras causas) acontecidas en el lacrosse de competicion, el deporte juvenil practicado con una frecuencia cada vez mayor en Estados Unidos. Resultados: Entre estudiantes tanto de instituto como universitarios que practicaban el deporte se identificaron 23 muertes subitas o paros cardiacos. Su edad era de 18 ± 22 anos; todos los atletas eran hombres. Fallecieron despues de un golpe contuso precordial 10 atletas, incluidos cuatro porteros que usaban protectores toracicos disponibles comercialmente. Los otros 12 experimentaron un sincope debido a una supuesta o documentada enfermedad cardiovascular, incluida una cardiomiopatia hipertrofica, sindrome del QT largo, prolapso de la valvula mitral o rotura de un aneurisma cerebral. La tasa de mortalidad asociada a este deporte fue de 1,46 muertes por 100.000 anos-persona y similar a la de otros deportes incluido el beisbol, baloncesto, futbol y hockey. Sin embargo, las muertes atribuidas a Commotio Cordis fueron mas frecuentes en el lacrosse (0,63 muertes por 100.000 anos-persona) que en los otros deportes (p < 0,02), con la excepcion del hockey. Conclusiones: En participantes en lacrosse de competicion las muertes subitas son poco frecuentes y no mas habituales que en la mayoria de los otros deportes. Estos acontecimientos catastroficos se debieron desproporcionadamente a Commotio Cordis e incluyeron a los atletas que usaban protectores toracicos, lo que destaca la importancia de desarrollar un dispositivo de proteccion toracica eficaz para crear un entorno atletico mas seguro para nuestros jovenes.
Barry J Maron - One of the best experts on this subject based on the ideXlab platform.
-
don t forget Commotio Cordis
American Journal of Cardiology, 2021Co-Authors: Barry J Maron, Mark S LinkAbstract:Non-penetrating chest blows can occasionally trigger fatal ventricular tachyarrhythmias and sudden death (Commotio Cordis). Such events were initially reported in association with sporting activities and projectiles such as baseball/lacrosse balls. However, similar potentially fatal chest blows, seemingly incapable of causing death, can occur during a variety of other circumstances such as when delivered during a fight (by a fist) such as in the accompanying paper. Notably, Commotio Cordis events can be reversed by resuscitation and defibrillation.
-
size as an important determinant of chest blow induced Commotio Cordis
Medicine and Science in Sports and Exercise, 2018Co-Authors: Christopher Madias, Barry J Maron, Cynthia Bir, Nathan Dau, N A Estes, Mark S LinkAbstract:PURPOSE Commotio Cordis is sudden cardiac death caused by a relatively innocent blow to the left chest wall. Adolescents account for the majority of the cases; whether this is due to the higher frequency of adolescents playing ball sports or whether there is some maturational reduction of risk is not known. METHODS In a swine model of Commotio Cordis, the effect of body weight/size (directly related to age) to the susceptibility of chest impact-induced ventricular fibrillation (VF) is examined. METHODS Ball impacts were delivered at escalating velocities from 48.3 to 96.9 km·h (30-60 mph) to 128 swine ranging in weight from 5 to 54 kg. RESULTS VF occurred in 29% of impacts to the smallest animals compared with 34% in the 14- to 239-kg group, 27% in the 24- to 33.9-kg group, 30% in 34- to 43-kg group, and 15% in the 44- to 54-kg animals. The highest-weight group was associated with a significantly lower incidence of VF compared with other weights (P = 0.002). In a multivariate logistic regression analysis, controlling for repeated measures, four variables predicted VF: body weight (P = 0.0008), velocity (P < 0.0001), distance from the center of the heart, (P < 0.0001), and peak left ventricular pressure induced by the blow (P = 0.0007). CONCLUSIONS In this experimental model, animals weighing <44 kg seem to have a similar susceptibility to Commotio Cordis, whereas animals weighing ≥44 kg have a lower susceptibility. An increase in size of the individual, rather than reduced play of ball sports, is the likely reason for the decreased Commotio Cordis incidence in older individuals.
-
eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities task force 13 Commotio Cordis a scientific statement from the american heart association and american college of cardiology
Circulation, 2015Co-Authors: Mark S Link, N Mark A Estes, Barry J MaronAbstract:Commotio Cordis is defined as sudden cardiac death triggered by a relatively innocent blow to the precordium.1 Although initially thought to be extremely rare, it is now increasingly reported in the United States and worldwide.2,3 Enhanced recognition of Commotio Cordis, rather than an increase in event frequency, likely accounts for the greater visibility of those events. Commotio Cordis is one of the most common causes of sudden cardiac death in recreational and competitive sports, instantaneously resulting in a potentially fatal arrhythmia.4 Commotio Cordis is distinct from cardiac contusion, in which structural damage to the heart with resultant arrhythmias develops within 24 hours after severe chest impact.5 Risk factors for a Commotio Cordis have been defined by a Commotio Cordis Registry of clinical events and an experimental swine model. Human cases occur largely in adolescent males (95% of cases), with a mean age of 14 years.2 Impacts occur over the left chest wall and are generally sustained with a hard spherical object such as a baseball, hockey puck, lacrosse ball, or softball. Collapse is instantaneous or within a few seconds; when a defibrillator is used rapidly, the arrhythmia is typically ventricular fibrillation (VF). An experimental model of Commotio Cordis has confirmed the arrhythmia induced by a chest blow is VF.6 Impact must occur over the cardiac silhouette, and harder balls are more likely to induce VF.6–8 In addition, this model has demonstrated the critical importance of timing in that only those blows that occur during a narrow time segment of the T-wave upstroke reliably produce VF.6 These laboratory experiments have also shown the importance of size and shape of the object.9 Blows must occur directly perpendicular to the chest wall to produce VF, and impact velocities optimal to …
-
increasing survival rate from Commotio Cordis
Heart Rhythm, 2013Co-Authors: Barry J Maron, Tammy S Haas, Aneesha Ahluwalia, Ross Garberich, N Mark A Estes, Mark S LinkAbstract:Background Commotio Cordis events due to precordial blows triggering ventricular fibrillation are a cause of sudden death (SD) during sports and also daily activities. Despite the absence of structural cardiac abnormalities, these events have been considered predominantly fatal with low survival rates. Objective To determine whether expected mortality rates for Commotio Cordis have changed over time, associated with greater public visibility. Methods US Commotio Cordis Registry was accessed to tabulate frequency of reported SD or resuscitated cardiac arrest over 4 decades. Results At their Commotio Cordis event, 216 study patients were 0.2-51 years old (mean age 15±9 years); 95% were males. Death occurred in 156 individuals (72%), while the other 60 (28%) survived. Proportion of survivors increased steadily with concomitant decrease in fatal events. For the initial years (1970-1993), 6 of 59 cases survived (10%), while during 1994-2012, 54 of 157 (34%) survived (P = .001). The most recent 6 years, survival from Commotio Cordis was 31 of 53 (58%), with survivor and nonsurvivor curves ultimately crossing. Higher survival rates were associated with more prompt resuscitation (40% 3 minutes; P Conclusions Survival from Commotio Cordis has increased, likely owing to more rapid response times and access to defibrillation, as well as greater public awareness of this condition.
-
abstract 19706 increasing survival and decreasing sudden death rate from Commotio Cordis
Circulation, 2012Co-Authors: Barry J Maron, Tammy S Haas, Aneesha Ahluwalia, Ross Garberich, N Mark A Estes, Mark S LinkAbstract:Introduction. Commotio Cordis events due to precordial blows triggering ventricular fibrillation are a cause of sudden death (SD) in competitive and recreational sports and normal daily activities. Despite normal cardiac structure, these events have been considered predominantly fatal with survival rates of < 20%. Hypothesis. To determine whether there has been a change in the expected mortality rate for Commotio Cordis over time, associated with (or due to) greater public visibility of this condition. Methods. U.S. Commotio Cordis Registry was accessed to tabulate the frequency of resuscitated cardiac arrest or SD from 1970 to 2012. Results. At the time of their Commotio Cordis event, 215 study patients were 1 to 50 years old, mean 15; 95% were male. Death due to Commotio Cordis occurred in 156 individuals (73%), and the other 59 (27%) survived. Notably, the proportion of Commotio Cordis survivors increased steadily with a concomitant decrease in fatal events over 43 years: for the first 24 years (1970-1...
S Mark M D Link - One of the best experts on this subject based on the ideXlab platform.
-
cell membrane stretch and chest blow induced ventricular fibrillation Commotio Cordis
Journal of Cardiovascular Electrophysiology, 2008Co-Authors: M Christopher D Madias, N Mark A Estes, J Barry M D Maron, B Stacey A Supron, S Mark M D LinkAbstract:Introduction: Commotio Cordis, sudden cardiac death secondary to blunt nonpenetrating chest blows in sports, is reported with increasing frequency. In a swine model, ventricular fibrillation (VF) is induced by a baseball blow to the chest, and the initiation of VF is related to the peak left ventricular (LV) pressure produced by the blow. LV pressure changes likely result in cell membrane stretch and mechanical activation of ion channels. Disruption of cell cytoskeleton that anchors the cell membrane prior to precordial blows offers the opportunity to explore whether cell membrane deformation is critical to Commotio Cordis. Methods and Results: Twelve juvenile swine (mean 12.7 ± 1.6 kg) were randomized to intravenous normal saline (control, n = 6) or 10 mg of intravenous colchicine (n = 6), which is known to depolymerize microtubules. Animals were given up to six blows timed to the vulnerable portion of the cardiac cycle with a 30 mph baseball on the chest directly over the cardiac silhouette. VF was initiated by 14 of the 29 (48%) impacts in the colchicine-treated animals compared with only 3 of 28 (11%) in the controls (P = 0.002). The peak generated LV pressure did not differ between colchicine animals (405 ± 61 mmHg) and controls (387 ± 115) (P = 0.47). However, animals administered colchicine were more likely to have VF generated by the chest blow at all pressures. Conclusion: The initiation of VF by chest blows is significantly increased by selective disruption of the cytoskeleton, suggesting that mechanical deformation of the cell membrane is fundamental to the activation of ion channels and underlies the mechanism of VF in Commotio Cordis.
-
Commotio Cordis sudden cardiac death with chest wall impact
Journal of Cardiovascular Electrophysiology, 2007Co-Authors: M Christopher D Madias, N Mark A Estes, J Barry M D Maron, M Jonathan D Weinstock, S Mark M D LinkAbstract:Commotio Cordis (CC), sudden death as a result of a blunt, often innocent-appearing chest wall blow, is being reported with increasing frequency. The clinical spectrum is diverse; however, a substantial number of cases occur in youth athletics. In events that occur during sport, victims are struck by projectiles regarded as standard implements of the game. Sudden death is instantaneous and victims are most often found in ventricular fibrillation (VF). Overall survival is poor; however, successful resuscitation can be achieved with early defibrillation. Autopsy is notable for the absence of any significant cardiac or thoracic injury. Development of an experimental model has allowed for substantial insights into the underlying mechanisms of sudden death. In anesthetized juvenile swine, induction of VF is instantaneous following chest wall blows occurring during a vulnerable window before the T wave peak. Crucial variables including the velocity of impact, impact location, and hardness of the impact object have been identified. Rapid left ventricular (LV) pressure rise following chest impact likely results in activation of ion channels via mechano-electric coupling. The generation of inward current via mechano-sensitive ion channels likely results in augmentation of repolarization and nonuniform myocardial activation, and is the cause of premature ventricular depolarizations that are triggers of VF in CC. While softer-than-standard safety baseballs reduce the risk of CC, commercially available chest protectors are ineffective in preventing CC. The development of more effective chest protectors and more widespread use of automated external defibrillators at youth sporting events are needed.
-
role of streptomycin sensitive stretch activated channel in chest wall impact induced sudden death Commotio Cordis
Journal of Cardiovascular Electrophysiology, 2005Co-Authors: R Arthur M D Garan, N Mark A Estes, J Barry M D Maron, J Paul M D Wang, S Mark M D LinkAbstract:Stretch-Activated Channel in Commotio Cordis. Introduction: Deaths secondary to low-energy impacts to the precordium in young individuals (Commotio Cordis) have been reported with increasing frequency. In a swine model, baseball impacts induce ventricular fibrillation when directed at the center of the left ventricle during the vulnerable portion of repolarization just prior to the T-wave peak. It has been hypothesized that activation of stretch-sensitive channels could be crucial for this electrophysiological phenomenon. In this study, a nonselective stretch-activated cation channel was pharmacologically blocked prior to chest blows to determine whether this channel represents a possible pathway by which Commotio Cordis events occur. Methods: In a randomized and blinded experiment, 12 swine (mean 17.1 ′ 2.5 kg) received either 2-g streptomycin intramuscularly (mean serum concentration 115 ′ 18 μM) or sterile water prior to chest impact. Each animal received six precordial impacts with a baseball propelled at 40 mph. Results: There was no significant difference in the frequency of induced VF in the animals administered streptomycin (10 of 19 impacts: 53%) compared to those control animals receiving only sterile water (10 of 31: 32%) (P = 0.15). However, the magnitude of ST segment elevation was less in the streptomycin-treated animals (19 ′ 19 mV) versus controls (61 ′ 46 mV) (P = 0.015). Conclusion: Streptomycin did not alter the frequency of ventricular fibrillation in our Commotio Cordis model, indicating that the stretch-activated channel is not implicated in the genesis of chest blow-induced cardiac arrest. However, streptomycin did reduce ST elevation following impact suggesting that the stretch-activated channel may play a role in ST segment elevation following chest wall blows.
-
automated external defibrillator arrhythmia detection in a model of cardiac arrest due to Commotio Cordis
Journal of Cardiovascular Electrophysiology, 2003Co-Authors: S Mark M D Link, J Barry M D Maron, Ronald E Stickney, A Brian B A Vanderbrink, M Wei D Zhu, G Natesa M D Pandian, J Paul M D Wang, N Mark A EstesAbstract:AED in Commotio Cordis. Introduction: Cardiac arrest due to chest wall blows (Commotio Cordis) has been reported with increasing frequency in children, and only about 15% of victims survive. Automated external defibrillators (AEDs) have been shown to be life saving in adults with cardiac arrest, but data on their use in children are limited. In a swine model of Commotio Cordis designed to be most relevant to young children, we assessed the efficacy of a commercially available AED for recognition and termination of ventricular fibrillation. Methods and Results: Ventricular fibrillation was produced in anesthetized juvenile swine by precordial impact from a baseball under controlled conditions. Animals were randomized to defibrillation after 1, 2, 4, or 6 minutes of ventricular fibrillation. Twenty-six swine underwent 50 ventricular fibrillation inductions. Sensitivity of the AED for recognition of ventricular fibrillation was 98%, and specificity for nonshockable episodes was 100%. All episodes of ventricular fibrillation were successfully terminated by the AED. Conclusion: In this experimental model of Commotio Cordis, the AED proved to be highly sensitive and specific for recognition of ventricular fibrillation and effective in terminating the arrhythmia and restoring sinus rhythm. These findings suggest that early defibrillation with the AED could save young lives on the athletic field.
-
automated external defibrillator arrhythmia detection in a model of cardiac arrest due to Commotio Cordis
Journal of Cardiovascular Electrophysiology, 2003Co-Authors: S Mark M D Link, J Barry M D Maron, Ronald E Stickney, A Brian B A Vanderbrink, G Natesa M D Pandian, J Paul M D Wang, N Mark A EstesAbstract:INTRODUCTION: Cardiac arrest due to chest wall blows (Commotio Cordis) has been reported with increasing frequency in children, and only about 15% of victims survive. Automated external defibrillators (AEDs) have been shown to be life saving in adults with cardiac arrest, but data on their use in children are limited. In a swine model of Commotio Cordis designed to be most relevant to young children, we assessed the efficacy of a commercially available AED for recognition and termination of ventricular fibrillation. METHODS AND RESULTS: Ventricular fibrillation was produced in anesthetized juvenile swine by precordial impact from a baseball under controlled conditions. Animals were randomized to defibrillation after 1, 2, 4, or 6 minutes of ventricular fibrillation. Twenty-six swine underwent 50 ventricular fibrillation inductions. Sensitivity of the AED for recognition of ventricular fibrillation was 98%, and specificity for nonshockable episodes was 100%. All episodes of ventricular fibrillation were successfully terminated by the AED. CONCLUSION: In this experimental model of Commotio Cordis, the AED proved to be highly sensitive and specific for recognition of ventricular fibrillation and effective in terminating the arrhythmia and restoring sinus rhythm. These findings suggest that early defibrillation with the AED could save young lives on the athletic field.
Christopher Madias - One of the best experts on this subject based on the ideXlab platform.
-
size as an important determinant of chest blow induced Commotio Cordis
Medicine and Science in Sports and Exercise, 2018Co-Authors: Christopher Madias, Barry J Maron, Cynthia Bir, Nathan Dau, N A Estes, Mark S LinkAbstract:PURPOSE Commotio Cordis is sudden cardiac death caused by a relatively innocent blow to the left chest wall. Adolescents account for the majority of the cases; whether this is due to the higher frequency of adolescents playing ball sports or whether there is some maturational reduction of risk is not known. METHODS In a swine model of Commotio Cordis, the effect of body weight/size (directly related to age) to the susceptibility of chest impact-induced ventricular fibrillation (VF) is examined. METHODS Ball impacts were delivered at escalating velocities from 48.3 to 96.9 km·h (30-60 mph) to 128 swine ranging in weight from 5 to 54 kg. RESULTS VF occurred in 29% of impacts to the smallest animals compared with 34% in the 14- to 239-kg group, 27% in the 24- to 33.9-kg group, 30% in 34- to 43-kg group, and 15% in the 44- to 54-kg animals. The highest-weight group was associated with a significantly lower incidence of VF compared with other weights (P = 0.002). In a multivariate logistic regression analysis, controlling for repeated measures, four variables predicted VF: body weight (P = 0.0008), velocity (P < 0.0001), distance from the center of the heart, (P < 0.0001), and peak left ventricular pressure induced by the blow (P = 0.0007). CONCLUSIONS In this experimental model, animals weighing <44 kg seem to have a similar susceptibility to Commotio Cordis, whereas animals weighing ≥44 kg have a lower susceptibility. An increase in size of the individual, rather than reduced play of ball sports, is the likely reason for the decreased Commotio Cordis incidence in older individuals.
-
l type calcium channels do not play a critical role in chest blow induced ventricular fibrillation Commotio Cordis
Cardiology Research and Practice, 2016Co-Authors: Christopher Madias, Ann C Garlitski, John Kalin, Mark S LinkAbstract:Background. In a Commotio Cordis swine model, ventricular fibrillation (VF) can be induced by a ball blow to the chest believed secondary to activation of mechanosensitive ion channels. The purpose of the current study is to evaluate whether stretch induced activation of the L-type calcium channel may cause intracellular calcium overload and underlie the VF in Commotio Cordis. Method and Results. Anesthetized juvenile swine received 6 chest wall strikes with a 17.9 m/s lacrosse ball timed to the vulnerable period for VF induction. Animals were randomized to IV verapamil () or placebo (). There was no difference in the observed frequency of VF between verapamil (19/26: 73%) and placebo (20/36: 56%) treated animals (). There was also no significant difference in the combined endpoint of VF or nonsustained VF (21/26: 81% in verapamil versus 24/36: 67% in controls, ). Conclusions. In this experimental model of Commotio Cordis, verapamil did not prevent VF induction. Thus, in Commotio Cordis it is unlikely that stretch activation of the L-type calcium channel with resultant intracellular calcium overload plays a prominent role.
-
reduced diameter spheres increases the risk of chest blow induced ventricular fibrillation Commotio Cordis
Heart Rhythm, 2011Co-Authors: John Kalin, Alawi A Alsheikhali, Christopher Madias, Mark S LinkAbstract:Background Sudden death due to low-energy blunt trauma to the precordium (Commotio Cordis) has been described with a variety of sporting objects. However, the risk of ventricular fibrillation (VF) relative to the shape of the impact object is not known. Objective The objective of the current experiment is to test whether the impact object shape is a clinical variable that affects the risk for Commotio Cordis. Methods In a juvenile swine model, impacts were given in random order with two different spherical shapes (72 mm diameter, equivalent to a baseball; 42 mm diameter, equivalent to a golf ball) and a flat round object 72 mm in diameter. Objects were equal in weight (150 g), thrown at 30 mph, and gated to the vulnerable portion of the cardiac cycle. Results Sixteen swine received 144 impacts. The flat object did not cause VF ( P = .01 compared with the two spherical objects), nonsustained VF, ST elevation, or bundle branch block. The smaller diameter sphere caused VF in nine of 48 impacts (19%), and the larger diameter sphere caused VF in five of 48 impacts (10%; P = .25). The smaller diameter sphere was associated with a greater increase in left ventricular pressure ( P P = .001 compared with larger sphere only) and a higher likelihood of ST segment elevations ( P P = .08 compared with larger sphere only) and bundle branch block (Fisher's exact P = .008, and Fisher's exact P = .18 compared with larger sphere only). Conclusion The shape of the projectile markedly influences the risk of VF from chest wall impact. This effect is likely mediated via a greater increase in left ventricular pressure with smaller diameter objects. Spreading the impact force over a larger area may decrease the risk of sudden death and has implications for the design of protective athletic equipment.
-
Marked Variability in Susceptibility to Ventricular Fibrillation in an Experimental Commotio Cordis Model
Circulation, 2010Co-Authors: Alawi A. Alsheikh-ali, Christopher Madias, Stacey Supran, Mark S LinkAbstract:Background—Precordial blows in sports and daily activities can trigger ventricular fibrillation (VF) (Commotio Cordis). Whereas chest wall blows are common, Commotio Cordis is rare. Although factors such as timing, location, orientation, and energy of impact are critically important, we also hypothesize that there is individual susceptibility to Commotio Cordis. Using our model of Commotio Cordis, we evaluated individual animal susceptibility to VF induction and assessed animal characteristics that might be involved. Methods and Results—This retrospective analysis included 139 juvenile swine (weight, 8 to 54 kg) that were anesthetized and placed prone in a sling to receive chest wall strikes with a ball propelled at 30 to 40 mph. Each animal received a minimum of 4 impacts directly over the cardiac silhouette, all timed to a narrow vulnerable window during cardiac repolarization. Of 1274 total impacts, 360 impacts (28%) resulted in VF. There was wide variability in individual animal susceptibility to VF. ...
-
correlation of impact force and left ventricular pressure for chest impacts in an animal model for evaluation of Commotio Cordis protection
ASME 2008 Summer Bioengineering Conference Parts A and B, 2008Co-Authors: Nathan Dau, Mark S Link, Christopher Madias, Cynthia BirAbstract:Commotio Cordis (CC) is defined as sudden cardiac death from a chest impact without any observable physical damage. This phenomenon is most prevalent in the youth population, especially during sporting events. Over 85% of those affected do not survive [1].Copyright © 2008 by ASME