TY - JOUR
T1 - Postmortem Interrogation of Cardiac Implantable Electronic Devices
T2 - A 15-Year Experience
AU - Paratz, Elizabeth D.
AU - Block, Tomasz J.
AU - Stub, Dion A.
AU - La Gerche, Andre
AU - Kistler, Peter M.
AU - Kalman, Jonathan M.
AU - Strathmore, Neil
AU - Mond, Harry
AU - Woodford, Noel W.F.
AU - Burke, Michael
AU - Voskoboinik, Aleksandr
N1 - Funding Information:
Dr Paratz is supported by a National Health and Medical Research Council (NHMRC)/National Heart Foundation (NHF) co-funded Postgraduate Scholarship, Royal Australasian College of Physicians JJ Billings Scholarship and PSA Insurance Cardiovascular Scholarship. Dr Stub is supported by a NHF Future Leadership Fellowship. Dr La Gerche is supported by an NHF Future Leadership Fellowship and an NHMRC Career Development Fellowship. Dr Voskoboinik is supported by an NHMRC EL1 Investigator Grant and an NHF Early Career Fellowship. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/3
Y1 - 2022/3
N2 - Objectives: This study sought to define the feasibility and utility of postmortem cardiac implantable electronic device (CIED) interrogation. Background: The diagnostic yield of routine postmortem interrogation of CIEDs including pacemakers, defibrillators, and implantable loop recorders has not been established. Methods: The study reviewed all CIED interrogations in deceased individuals undergoing medicolegal investigation of sudden or unexplained death by the Victorian Institute of Forensic Medicine between 2005 and 2020. Results: A total of 260 patients (68.8% male, median age 72.8 years [interquartile range: 62.7-82.2 years]) underwent CIED interrogation (202 pacemakers, 56 defibrillators, and 2 loop recorders) for investigation of sudden (n = 162) or unexplained (n = 98) death. CIEDs were implanted for median of 2.0 years (interquartile range: 0.7-5.0 years), with 19 devices at elective replacement indicator and 5 at end of life. Interrogation was successful in 256 (98.5%) cases. Potential CIED malfunction was identified in 20 (7.7%) cases, including untreated ventricular arrhythmias (n = 13) and lead failures (n = 3, 2 resulting in untreated ventricular arrhythmia). Interrogation directly informed cause of death in 131 (50.4%) cases. A total of 72 (27.7%) patients had abnormalities recorded in 30 days preceding death: nonsustained ventricular tachycardia (n = 26), rapid atrial fibrillation (n = 17), elective replacement indicator or end-of-life status (n = 22), intrathoracic impedance alarms (n = 3), lead issues (n = 3), or therapy delivered (n = 1). In 6 cases in which the patient was found deceased after a prolonged period, interrogation determined time of death. In 1 case, CIED interrogation was the primary means of patient identification. Conclusions: Postmortem CIED interrogation frequently contributes important information regarding critical device malfunction, premortem abnormalities, mechanism, and time of death or patient identity. Device interrogation should be considered for select patients with CIEDs undergoing autopsy.
AB - Objectives: This study sought to define the feasibility and utility of postmortem cardiac implantable electronic device (CIED) interrogation. Background: The diagnostic yield of routine postmortem interrogation of CIEDs including pacemakers, defibrillators, and implantable loop recorders has not been established. Methods: The study reviewed all CIED interrogations in deceased individuals undergoing medicolegal investigation of sudden or unexplained death by the Victorian Institute of Forensic Medicine between 2005 and 2020. Results: A total of 260 patients (68.8% male, median age 72.8 years [interquartile range: 62.7-82.2 years]) underwent CIED interrogation (202 pacemakers, 56 defibrillators, and 2 loop recorders) for investigation of sudden (n = 162) or unexplained (n = 98) death. CIEDs were implanted for median of 2.0 years (interquartile range: 0.7-5.0 years), with 19 devices at elective replacement indicator and 5 at end of life. Interrogation was successful in 256 (98.5%) cases. Potential CIED malfunction was identified in 20 (7.7%) cases, including untreated ventricular arrhythmias (n = 13) and lead failures (n = 3, 2 resulting in untreated ventricular arrhythmia). Interrogation directly informed cause of death in 131 (50.4%) cases. A total of 72 (27.7%) patients had abnormalities recorded in 30 days preceding death: nonsustained ventricular tachycardia (n = 26), rapid atrial fibrillation (n = 17), elective replacement indicator or end-of-life status (n = 22), intrathoracic impedance alarms (n = 3), lead issues (n = 3), or therapy delivered (n = 1). In 6 cases in which the patient was found deceased after a prolonged period, interrogation determined time of death. In 1 case, CIED interrogation was the primary means of patient identification. Conclusions: Postmortem CIED interrogation frequently contributes important information regarding critical device malfunction, premortem abnormalities, mechanism, and time of death or patient identity. Device interrogation should be considered for select patients with CIEDs undergoing autopsy.
KW - cardiac implantable electronic device
KW - forensic
KW - pacemaker
KW - postmortem
UR - http://www.scopus.com/inward/record.url?scp=85126149118&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2021.10.011
DO - 10.1016/j.jacep.2021.10.011
M3 - Article
C2 - 35331431
AN - SCOPUS:85126149118
SN - 2405-500X
VL - 8
SP - 356
EP - 366
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 3
ER -