Precordial Thump in the Catheterization Laboratory Experimental Evidence for Commotio Cordis
A 57-year-old man was admitted to our institution for a diagnostic coronarography. During the right coronary injection (Iomeron 350, Altana Pharma, Le Mée sur Seine, France), complete atrioventricular block occurred for 3 seconds. A precordial thump was performed to restart cardiac activation. Unfortunately, the precordial thump occurred during repolarization of the first ventricular escape rhythm, resulting in ventricular fibrillation, which required external cardioversion. This is the first case documented of ventricular fibrillation initiation in a man by mild chest trauma. In commotio cordis—infrequent sudden death in young athletes caused by blunt chest trauma—ventricular fibrillation is induced by a light blow delivered at a wide range of velocities, as documented in an animal model.1 This tracing (Figure) is highly remarkable in that precordial thump, a common resuscitation maneuver, was responsible for commotio cordis, resulting in ventricular fibrillation that necessitated immediate cardioversion.