Commotio Cordis Follow-up

Updated: Jan 04, 2016
  • Author: Steven M Yabek, MD, FAAP, FACC; Chief Editor: Stuart Berger, MD  more...
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The 36th Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities had a number of recommendations regarding commotio cordis. [8]

Children and adolescents aged 13 years and younger should use age-appropriate safety baseballs.

Although commercial chest wall protectors prevent traumatic injury in some instances, the construction of many products is not sufficient to prevent transmission of blows to the heart. Among professional athletes who suffered a commotio cordis event, 1/3 were wearing commercially availabe chest protectors.

All sports venues should have immediate access (within 5 min) to an automated external defibrillator (AED).

Survivors of commotio cordis should undergo a thorough cardiac evaluation, including a 12-lead ECG, ambulatory Holter monitoring, and complete echocardiography.

Eligibility for returning to competitive sports following a commotio cordis episode is, at present, a decision left to individual clinical judgment. No evidence suggests that survivors of commotio cordis have a greater risk of future arrhythmic events. The role of subclinical long QT syndrome as a potential cause for increased susceptibility, as suggested by animal studies, needs further investigation.

Because risk is proportional to the hardness and compactness of the object that strikes the precordium, consideration may be given to the use of specially designed, softer-than-normal safety baseballs in recreational and Little League baseball.



Survival from a commotio cordis event is improving. Based on the most recent US Commotio Cordis Registry data, 58% of individuals have survived a commotio cordis episode in recent years. Overall, survival trends following exercise- or sports-related sudden cardiac arrest from all causes in young athletes is improving. [9]

Failure of timely resuscitation efforts may relate to several factors, the most important of which is the presence of structural heart disease. In those with an anatomically normal heart suffering a commotio cordis event, the duration and intensity of exercise prior to arrest, higher than normal endogenous catecholamine levels and a decrease in systemic vascular resistance may all play a role in limiting the success of resuscitation. [10]

Standard chest compressions following electrical defibrillation may predispose to episodes of repeated refibrillation, thereby limiting the effectiveness of resuscitation. Despite the current AHA Guidelines, some studies have demonstrated that chest compressions can result in electrical capture of the ventricles, which, under certain conditions, may lead to so-called "long-short" electrical sequences that reinitiate fibrillation. [11]