Exploring postmortem practices for cardiac device interrogation in the UK

Ascertaining the cause of sudden death is often difficult, even in patients with a history of heart disease. Device interrogation is routinely carried out to determine the nature of symptoms or aborted sudden death episodes in patients with cardiac implantable electronic devices (CIED), but it is not clear how often this is done postmortem, and if so, how this information is recorded and used by clinical teams and coroners.

We determined the proportion of deaths with a CIED in situ, the capacity for and frequency of postmortem device interrogation and when done, how the information was used over a 5-year period in the UK by surveying 173 National Health Service (NHS) trusts via a freedom of information request.

A response was received from 83 (48%) NHS sites, 75 (90%) of which reported having both a mortuary and cardiac physiology department onsite. During the period 2019-2024, each mortuary handled 2400±1094 deaths per annum, of which an estimated 5±2% had a CIED in place. Of those with cardiac physiology on site, only 15 (20%) reported routine postmortem device checks were performed. If such a check was conducted, 3 out of 15 (20%) responded that findings were documented in the medical records and 2 out of 15 (13%) stated information was relayed to the medical team.

Although 1 in 20 patients who present to NHS mortuaries have a CIED in situ, routine postmortem checks are performed rarely and inconsistently documented. Prospective studies are warranted to determine the feasibility and utility of standardised postmortem device interrogation.