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]


The most common rhythm observed in commotio cordis cases is ventricular fibrillation (VF). Other arrhythmias such as polymorphic ventricular tachycardia, complete heart block, idioventricular rhythm, atrial fibrillation, ST-segment elevation, T-wave abnormalities were reported. 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.


Six lead electrocardiogram and intraventricular pressure measurement from an 11 kg swine undergoing a 48 km/h (30 mph) chest wall impact with an object the shape and weight of a standard baseball[4]
Electrocardiogram schematic tracing, showing the period of vulnerability to stretch-induced ventricular fibrillation which occurs in commotio cordis.


  1. 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.
  2. 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).
  3. 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.
  4. Madias C, Maron BJ, Alsheikh-Ali AA, Estes Iii NA, Link MS (October 2007). "Commotio cordis". Indian Pacing Electrophysiol J. 7 (4): 235–45. PMC 2018736. PMID 17957272.

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