Commotio cordis electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maryam Hadipour, M.D.[2]

Overview

Electrocardiogram (ECG) findings in commotio cordis can vary depending on the timing of the ECG recording and the presence of arrhythmias.
The most common rhythm observed in commotio cordis cases is ventricular fibrillation (VF). Other arrhythmias were reported, such as:
- Polymorphic ventricular tachycardia
- Complete heart block
- Idioventricular rhythm
- Atrial fibrillation
- ST-segment elevation
- T-wave abnormalities
The timing and location of the impact are crucial in the generation of VF in commotio cordis. When the impact occurs directly over the heart within a specific window during the upslope of the T wave in ventricular repolarization, it triggers a rapid increase in left ventricular intracavitary pressure, leading to VF.
It is important to note that ECG findings may not always be abnormal in commotio cordis cases. reported a case of commotio cordis where the patient did not show any arrhythmias and did not receive any resuscitation procedure. The ECG alterations observed in this case improved over time^[1]^[2]^[3].

↑ Maringhini G, Fasullo S, Vitrano G, Terrazzino G, Ganci F, Paterna S, Di Pasqual P (December 2012). "Commotio cordis without arrhythmic event and resuscitation: ECG, echocardiographic, angiographic and cardiovascular resonance imaging study". BMJ Case Rep. 2012. doi:10.1136/bcr-03-2011-3968. PMC 4543299. PMID 23234817.
↑ Patel N, Pena C, Nesheiwat Z, Zafrullah F, Eltahawy E (June 2022). "Ventricular fibrillation arrest after blunt chest trauma in a 33-year-old man, commotio cordis?". BMC Cardiovasc Disord. 22 (1): 252. doi:10.1186/s12872-022-02689-4. PMC 9166514 Check |pmc= value (help). PMID 35658897 Check |pmid= value (help).
↑ Ota K, Bratincsak A (January 2015). "Atrial fibrillation induced by commotio cordis secondary to a blunt chest trauma in a teenage boy". Pediatrics. 135 (1): e199–201. doi:10.1542/peds.2014-1972. PMID 25489014.
↑ Madias C., Maron J.M., Alsheikh-Ali A.A., Estes N.A.M., Link M.S. Commotio Cordis, Indian Pacing and Electrophysiology Journal 7 (4): 235-245 (2007) PMID 17957272