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Commotio cordis: a precordial thump?
  1. Divisione di Cardiologia, Ospedale “G Fornaroli”
  2. Via Donatori di Sangue 50
  3. 20013 Magenta (Milan), Italy

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Editor,—There has been growing interest in commotio cordis, defined as a rare type of sudden cardiac death after minor chest wall blows, mainly occurring in apparently healthy young people during sporting activity.1-3 However, this event may be more common, but usually misunderstood and underreported, because of misclassification with other cardiac diseases in different settings and at older ages, in patients with associated symptoms.

About 10 years ago I admitted a man in his 50s without known cardiac disease to a coronary care unit for ECG monitoring. He reported a history of prolonged episodes of haemodynamically well tolerated palpitations, which had never been clearly diagnosed as symptoms always spontaneously disappeared before any ECG recording. During ECG monitoring he had sustained ventricular tachycardia (180 beats/min) with his usual palpitations. Before using any antiarrhythmic drugs, I tried to stop the ventricular tachycardia with a chest thump, as I had successfully done many times in similar situations. Surprisingly, my thump instantaneously transformed the well tolerated ventricular tachycardia into ventricular fibrillation with immediate loss of consciousness. Cardioversion (dc shock 320 J) immediately restored sinus rhythm and the patient resuscitated. I now consider any chest thump as a potentially dangerous and proarrhythmic manoeuvre.

It is quite surprising that this kind of commotio cordis (chest thump) is commonly adopted as an emergency therapeutic tool in patients with ventricular arrhythmias to reset myocardial electrical potentials, but the same phenomenon is considered a curious clinical finding when it accidentally happens during the vulnerable period of the cardiac cycle in healthy but unlucky young people (chest wall impact). Have we long been discussing the existence of an electromechanical phenomenon (commotio cordis) that we commonly exploit in emergency departments with another name and in different clinical setting (precordial thump)?