Chest guards don't stop risks to heart
A blow from a ball or puck at a key moment can be fatal, and more protective gear is a drag on players.
BY REBECCA JUNGBAUER and JEREMY OLSON
Pioneer Press
Chest protectors do not prevent rare but fatal heart conditions that occur when baseballs, hockey pucks or other projectiles strike the upper body at precisely the wrong moment, according to research led by a Twin Cities cardiologist.
A registry has tracked 182 cases in the United States over the past decade involving a condition known as commotio cordis, which occurs when a chest blow triggers an irregular heartbeat. More than eight in 10 incidents resulted in deaths. Almost half of the cases involved athletes in competitive sports, and 33 deaths occurred even though athletes wore protective gear.
The condition is rare, considering the millions of children playing sports, but draws considerable public attention because it strikes otherwise healthy children in public settings. Parents need to know about it, and equipment manufacturers need to consider it in future designs, said Dr. Barry Maron, the lead author of the research presented Monday at the American Heart Association's annual meeting.
"It's tricky," said Maron, a cardiologist at the Minneapolis Heart Institute. "You're telling the public something they should know about, but there's nothing right now they can do about it."
The 33 deaths included 14 hockey players, 10 football players, six lacrosse players and three baseball players. Ten occurred from blows that directly struck the athletes' chest protectors. The other 23 occurred when projectiles, sticks or body checks missed the protective padding. Eight of the players were goalies or catchers, who typically wear protective gear.
Separate research in Boston verified that a baseball striking the chest at 30 mph can throw the heart into an irregular beat. However, the blow must occur during the 10- to 30-millisecond pause in electrical activity in the lower chambers of the heart.
Better padding that covers the entire chest wall might prevent deaths but also might be viewed as excessive when considering the rarity of deaths. Baseball players would have trouble pitching or batting if wearing clunky chest protection, said Dr. Bradley Bart, a cardiologist at Hennepin County Medical Center.
"I can't imagine it would be too comfortable to bat or run the bases with gear on," he said. "Practically, that's going to be pretty uncomfortable."
Alternative safety measures include placing defibrillators at parks and athletic fields or using softer "safety" balls.
Most of the patients in the registry were boys. Their average age was 15.
The study's funding came from the National Operating Committee on Standards for Athletic Equipment, which is made up of manufacturers, sports medicine specialists and athletic trainers and coaches.
"Hopefully," Maron said, "these data will represent a stimulus for developing a truly effective chest barrier that will be absolutely protective against the risk of these commotio cordis catastrophes."