Arrhythmias of a sudden traumatic death

A 73-year-old man was treated because of his paroxysmal palpitations became persistent. At the time of hospital admission atrial flutter was found. Antiarrhythmic drug treatment was unsuccessful therefore electrical cardioversion was indicated which restored his sinus rhythm. After one year of uneventful follow up Holter monitoring was indicated again. When the machine was hooked up sinus rhythm was observed. After 53 minutes a tram knocked down the patient, and he died immediately. During autopsy brain laceration, multiple cranial fractions, mediastinal hemorrhage were found. The Holter recording time was 66 minutes. Before the accident sinus rhythm was recorded. At the time of accident an electrical noise was found, followed by long sinus arrest, atrial fibrillation, nodal escape rhythm, sinus bradycardia, ventricular flutter, tachycardia, fibrillation and "dying heart" rhythm. According to our knowledge this is the first Holter monitoring observation during a sudden traumatic death.