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Postmortem interrogation of cardiac implantable electrical devices may clarify time and cause of death
Lisa Riesinger1, S Fichtner2, C G Schuhmann2
1Department of Cardiology, Medizinische Klinik und Poliklinik I, University Hospital Munich, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany. Lisa.Riesinger@med.uni-muenchen.de.
Insights
Postmortem interrogation of cardiac implantable electrical devices (CIED) can help determine the time and cause of death. Routine CIED interrogation in autopsies may clarify lethal arrhythmias and the day of death.
Area of Science:
- Forensic Pathology
- Cardiology
- Medical Device Technology
Background:
- Postmortem interrogation of cardiac implantable electrical devices (CIED) is not standard practice.
- The utility of CIED interrogation in determining time and cause of death is unclear.
Purpose of the Study:
- To investigate whether postmortem CIED interrogation can clarify the time and cause of death.
- To assess the diagnostic value of analyzing device parameters and event logs.
Main Methods:
- Seventy CIED from patients undergoing autopsy were interrogated.
- Device data (battery, leads, alerts, arrhythmias) were reviewed.
- Findings were correlated with autopsy and clinical data.
Main Results:
- Potentially lethal ventricular arrhythmias were identified in 9 of 70 patients.
- The day of death could be estimated in 36 patients (51%), clarifying time of death in 6 patients.
- CIED interrogation revealed ventricular tachycardia as a potential cause of death in 2 cases with initially unknown causes.
Conclusions:
- Postmortem CIED interrogation can reveal lethal arrhythmias and aid in estimating the time of death.
- Routine interrogation of CIED in autopsies is recommended to clarify time and cause of death.
Background:
Postmortem interrogation of cardiac implantable electrical devices (CIED) in autopsy is not routinely performed. Thus, it remains unclear whether an interrogation might clarify time and cause of death.
Methods:
Seventy of 4401 patients (1.6%) undergoing autopsy in 2014 and 2015 presented with a CIED. The explanted CIED were interrogated with respect to time and possible cause of death. Battery and lead parameters, clinical and technical alerts, and arrhythmia episodes were reviewed and afterwards correlated with the results of autopsy and clinical data.
Results:
Twenty-five implantable cardioverter defibrillators (ICD) and 45 pacemaker (PM) devices were analyzed. Death was classified as cardiac by autopsy in 17 of 70 patients. Accordingly, presumably lethal ventricular arrhythmias were documented in six patients (8.6%; 5 ICD, 1 PM). In two of 30 patients with unknown cause of death after autopsy (6.7%), interrogation revealed ventricular tachycardia as potential reason for decease (1 ICD, 1 PM). Postmortem CIED interrogation additionally allowed to make a statement regarding the day of death in 36 patients (51%; 13 ICD, 23 PM). This was in accordance with clinical data or the results of autopsy in nine patients (25%; 3 ICD, 6 PM) or could even clarify the time of death in six patients (16.7%; 4 ICD, 2 PM).
Conclusion:
Interrogation of CIED revealed potentially lethal ventricular arrhythmias in 9 of 70 patients investigated and enabled valid estimation of the day of death in 15 patients. We therefore conclude that routinely performed postmortem CIED interrogation may clarify time and cause of death.
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