"If a patient dies for unexplained reasons, a postmortem check of a pacemaker, implantable cardioverter-defibrillator (ICD), or implantable loop recorder can be helpful to determine cause of death," said Dr. Jordan M. Prutkin, a cardiac electrophysiologist, sports cardiologist, and professor of medicine at the University of Washington School of Medicine, in Seattle, who was not involved in the new research.
"The forensic aspect of this study is fascinating, demonstrating how you can use devices to determine date and even time of death, months after a body has been found," Dr. Prutkin told Reuters Health by email. "This is being done informally already, and most people who follow patients with CIEDs have been involved in these postmortem checks."
For the study, published in JACC: Clinical Electrophysiology, Dr. Aleksandr Voskoboinik of Alfred Hospital Heart Centre, in Prahran, and his colleagues reviewed fifteen years' worth of one forensic medical institute's CIED interrogation data from deceased persons who had undergone medicolegal investigation for sudden (162 people) or unexplained (98 people) death.
Overall, 68% of the deceased patients were male and the median age was 73 years. The data analysis involved 202 pacemakers, 56 defibrillators, and two loop recorders. Interrogations of 256 (98.5%) cases were successful.
CIEDs were implanted for a median of 2.0 years, 19 devices indicated elective replacement, and five were at the end of life. Potential CIED malfunction was found in 20 (7.7%) cases, including 13 untreated ventricular arrhythmias and three lead failures.
Interrogation directly revealed the cause of death of 131 (50.4%) patients: 72 (27.7%) had abnormalities recorded within 30 days of death, including 26 with nonsustained ventricular tachycardia, 17 with rapid atrial fibrillation, 22 with elective replacement indicator or end-of-life status, three with intrathoracic impedance alarms, three with lead issues, and one involving therapy delivered.
Device interrogation enabled one person to be identified and determined time of death of six people found long after they had died.
"We must continue to refine ICD sensing algorithms to sense and treat fine ventricular fibrillation," Dr. Prutkin advised. "This can also help families or authorities determine cause of death, which can help bring closure and answer questions when events are sudden or unexplained."
"I would encourage any physician or family member who has questions regarding the circumstances of a patient's death to get a check of the ICD postmortem," he added. "They may get their questions answered."
Dr. Christopher Cheung, a cardiac electrophysiology fellow at the University of California, San Francisco, said, "There is a clear need for ongoing work and collaboration with device manufacturers to improve these devices so potentially life-threatening malfunctions do not occur."
"We must be cognizant of the risk of cardiac device malfunction," he told Reuters Health by email. "Recognizing early signs of failure and working with device manufacturers to identify these malfunctions is critical so we can ensure that patients receive devices that will work properly."
"This is a well-done study, with a large cohort of patients with sudden death and a cardiac device in situ," said Dr. Cheung, who also was not involved in the study. "It is very informative for the field."
The study did not receive commercial support, and the authors report no conflicts of interest.
Dr. Voskoboinik was not able to provide comments in time for publication.
SOURCE: https://bit.ly/3EPY1G4 JACC: Clinical Electrophysiology, online December 22, 2021.
By Lorraine L. Janeczko
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