Article Synopsis
- Postmortem interrogations of cardiac implantable electronic devices (CIEDs) are rarely conducted in cases of sudden cardiac death, and prior systematic data is lacking in forensic pathology.
- A study analyzed data from 151 CIEDs across 150 subjects during autopsies from 2012 to 2017, showing that CIED interrogation helped clarify the cause and time of death in significant portions of cases where forensic autopsy could not.
- The findings highlight the importance of routine postmortem CIED analysis in forensic medicine for accurately determining death causes and identifying potential device safety issues.
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Article Abstract
Background: Postmortem interrogations of cardiac implantable electronic devices (CIEDs), recommended at autopsy in suspected cases of sudden cardiac death, are rarely performed, and data on systematic postmortem CIED analysis in the forensic pathology are missing. The aim of the study was to determine whether nonselective postmortem CIED interrogations and data analysis are useful to the forensic pathologist to determine the cause, mechanism, and time of death and to detect potential CIED-related safety issues.
Methods: From February 2012 to April 2017, all autopsy subjects in the department of forensic medicine at the University Hospital Charité who had a CIED underwent device removal and interrogation. Over the study period, 5368 autopsies were performed. One hundred fifty subjects had in total 151 CIEDs, including 109 pacemakers, 35 defibrillators, and 7 implantable loop recorders.
Results: In 40 cases (26.7%) time of death and in 51 cases (34.0%) cause of death could not be determined by forensic autopsy. Of these, CIED interrogation facilitated the determination of time of death in 70.0% of the cases and clarified the cause of death in 60.8%. Device concerns were identified in 9 cases (6.0%), including 3 hardware, 4 programming, and 2 algorithm issues. One CIED was submitted to the manufacturer for a detailed technical analysis.
Conclusions: Our data demonstrate the necessity of systematic postmortem CIED interrogation in forensic medicine to determine the cause and timing of death more accurately. In addition, CIED analysis is an important tool to detect potential CIED-related safety issues.
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| http://dx.doi.org/10.1161/CIRCULATIONAHA.117.032367 | DOI Listing |
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