Sudden cardiac arrest from commotio cordis in a competitive hurling athlete: case report

Commotio cordis is a rare, potentially fatal arrhythmic event precipitated by blunt trauma to the chest, typically during sports, in the absence of structural heart disease. The term, derived from Latin meaning ‘agitation of the heart’, reflects the mechanism in which a precisely timed impact during the vulnerable phase of ventricular repolarization induces ventricular fibrillation.

A 25-year-old male athlete with no past medical history or known cardiac conditions, and no family history of sudden cardiac death, suffered a cardiac arrest during an intermediate hurling championship match after a high-speed collision in which an opponent’s knee struck his anterior chest. Ventricular fibrillation was detected, and spontaneous circulation was restored after 1× shock. Extensive evaluation excluded structural or inherited cardiac disease. At 2-year follow-up, the patient remains asymptomatic, with serial echocardiograms and has resumed competitive hurling without restrictions.

Commotio cordis occurs when blunt chest trauma, precisely timed during the upslope of the T-wave, induces ventricular fibrillation or ventricular tachycardia. Our case demonstrates classic features of commotio cordis: a previously healthy adult with no personal or family history of cardiac disease, cardiac arrest temporally related to a precordial impact, rapid restoration of circulation via automated external defibrillator, and favourable long-term outcome¹ [Lampert R, Chung EH, Ackerman MJ, Drezner JA, Engel DJ, Gray B, et al. 2024 HRS expert consensus statement on arrhythmias in the athlete: evaluation, treatment, and return to play. Heart Rhythm 2024;21:e151–e252.].