Safety and behavior of implantable electronic devices during cremation

The current standard of practice for cremating patients with cardiac implantable electronic devices (CIEDs) is surgical explantation before cremation to mitigate the risk of device explosion. This surgery may conflict with patient or family beliefs, whereas cremation of CIEDs may create occupational hazards.

This study sought to establish an ex vivo model for screening CIED behavior during cremation.

Seven CIEDs underwent testing including projectile/sound testing, impact testing, and gas analysis. In the projectile test, devices were heated until thermal failure (explosion) and filmed with a high-speed camera and microphone. For impact testing, brick structures were built to assess damage after explosion. Gas chromatography-mass spectrometry identified released gases. Findings were compared with occupational health standards, where available.

The implantable loop recorder and leadless pacemaker produced minimal kinetic energy and impact risk with thermal failure. The remaining devices demonstrated explosive disintegration at thermal temperatures <500°C. The pacemakers and implantable cardiac defibrillators produced sound levels >120 dB and resulted in damage to brick structures. Small quantities of benzene and hydrogen fluoride were produced but at quantities within acceptable occupational exposure limits in a cremation chamber.

All tested CIEDs experienced explosion at temperatures below crematorium standards. The smallest devices produced minimal risk of damage or injury, suggesting that they may safely remain in situ during cremation, whereas the larger devices produced more kinetic energy, testing chamber damage, and louder explosions, suggesting potential risk with cremation. Cadaveric testing in full-sized cremation chambers is required to determine real-world risk.