Cardiovascular Implantable Electronic Devices -> Monitoring & Outcomes: -> Monitoring & Follow-up D-PO05 - Poster Session V (ID 39) Poster

D-PO05-094 - Post-mortem Cardiovascular Implantable Electronic Device Interrogation In Patients Undergoing Autopsy (ID 1263)

Abstract

Background: Interrogations of cardiac implantable electronic devices (CIED) are rarely performed at autopsies of sudden or unexplained death.
Objective: To obtain post-mortem CIED data of patients undergoing autopsy and thereby reveal the cause of death or device malfunction.
Methods: From April 18th, 2016, to November, 6th, 2019 full autopsy, device removal and interrogation were performed by the Institute of Legal Medicine and the Department of Electrophysiology of the University Hospital of Cologne in all patients undergoing autopsy and having a CIED as part of the clinical routine.
Results: 88 patients undergoing autopsy had CIEDs removed and analyzed (17 ICD, 60 pacemakers, 4 loop recorder, 7 CRT-D). 44 patients died of a natural cause, 24 of an unnatural cause, 20 could not be determined. At time of death, 16 patients had sustained tachyarrhythmia. 4 had atrial fibrillation, 2 of them exceeding 200 bpm. 8 patients suffered from ventricular fibrillation (VF) and 4 patients suffered from ventricular tachycardia (VT) at their time of death. 1 patient had a loop recorder which showed ventricular tachycardia not responding to external defibrillation, 1 had an ICD which failed to terminate VT. 1 patient with loop recorder had multiple episodes of asystole resulting in a sinus arrest. Overall, 31 patients had documented arrhythmia in their Holter prior to their death. Device complications only occurred in 3 patients. All of them had a ventricular lead warning. 1 with a decrease in the impedance two weeks before his death. 1 ICD was showing artefacts sensed as VF days before his death causing 2 inappropriate shocks. The other patient suffered from indistinguishable low voltage electrical signal non-compatible to VT or VF criteria of his ICD. No malfunctions could be found. 1 patient’s date of death could be determined by interrogation as the body was decomposed when found (decrease in patient activity, sudden rise of ventricular stimulation).
Conclusion: Systematic post-mortem interrogation in CIED patients undergoing autopsy was clinically useful in assisting with determination of the mechanism, the time and cause of death in 88 patients. Current surveillance standards may underestimate device malfunction, programming mistakes or cardiac arrhythmia at the time of death.
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