Commotio cordis primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Primary Prevention
The prevention of commotio cordis is crucial in reducing the incidence of this life-threatening condition.
- One preventive measure is the use of safety baseballs, which have been shown to reduce the risk of commotio cordis in experimental models. These safety baseballs are designed to be softer than regulation balls, and they have been recommended by the Consumer Product Safety Commission as a means to decrease injuries in youth baseball. Experimental models have demonstrated a relationship between the hardness of the baseball and the likelihood of ventricular fibrillation, the primary mechanism of commotio cordis.
- Other preventive measures include the use of chest wall protectors. Chest wall protectors, such as those used in ice hockey, can help soften the impact of projectiles and reduce the induction of ventricular fibrillation. However, recent studies indicated that there is no clear evidence of the effectiveness of chest protectors in reducing the risk of commotio cordis.
- Education and awareness among coaches, trainers, and participants in high-risk sports events are also important preventive strategies[1].
Resume of activities
In order to rule out structural heart disease, commotio cordis patients must have a cardiac workup. This includes stress tests, ambulatory ECG monitoring, echocardiograms, magnetic resonance imaging, and ECGs. In the presence of characteristic electrocardiographic signs, pharmacological testing for Brugada and long-QT syndromes should also be taken into consideration. Even genetic testing might be taken into consideration when long-QT syndrome is a possible differential diagnosis. Implantable cardioverter defibrillators are not advised for commotio cordis survivors if there is no underlying cardiac illness [2]