Postmortem ICD interrogation in mode of death classification

Nikolaidou, Theodora; Johnson, Miriam J.; Ghosh, Justin; Marincowitz, Carl; Shah, Saumil; Lammiman, Michael J.; Schilling, Richard J.; Clark, Andrew L.

doi:10.1111/jce.13414

Cited by 9 publications

(5 citation statements)

References 33 publications

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“…However, multiple reports have revealed that generic compliance with guideline directed ICD programming recommendations, with or without undersensing, may lead to delayed or in some instances even withholding delivery of the HV therapy [13][14][15]23 . Moreover, post-mortem studies suggest that mortality in ICD implanted patients can be due to undertreated ventricular tachyarrhythmias 13,18,24,25 . It is well recognized that undersensing of ventricular signals (R-waves) during VF in ICDs is a known limitation of the therapy 7 .…”

Section: Discussionmentioning

confidence: 99%

“… 13 , 14 , 15 , 23 Moreover, postmortem studies suggest that mortality in ICD-implanted patients can be due to undertreated ventricular tachyarrhythmias. 13 , 18 , 24 , 25 It is well recognized that undersensing of ventricular signals (R waves) during VF in ICDs is a known limitation of the therapy. 7 While occasional undersensed events do not typically delay detection and treatment, the likelihood of this occurrence may be higher when longer detection times and/or faster detection rates are programmed.…”

Section: Discussionmentioning

confidence: 99%

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Novel ventricular tachyarrhythmia detection enhancement detects undertreated life-threatening arrhythmias

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Novel ventricular tachyarrhythmia detection enhancement detects undertreated life-threatening arrhythmias

et al. 2022

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“…This is particularly important in unclear cases when traditional post-mortem diagnostics do not show significant changes that could have led to death [18,50]. Such situations include, among others, sudden cardiac death as a result of cardiac arrhythmias in the functional mechanism, which may not cause any specific changes that can be visualized during an autopsy [51][52][53]. It is also important in the case of poisoning or overdose of drugs that may not leave macroscopically visible changes during post-mortem examination but may affect the cardiac function.…”

Section: Forensic Medicinementioning

confidence: 99%

Remember by heart – the importance of post-mortem cardiac implantable electronic device analysis

Rzepczyk,

Migiel,

Bijata

et al. 2023

Eur J Trans Clin Med

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In recent years, the number of patients with a cardiac implantable electronic device (CIED) has been steadily increasing. Implantable cardioverter-defibrillators (ICDs) are currently one of the primary methods of preventing sudden cardiac death (SCD) in patients at risk. A post-mortem CIED examination, which these days is performed very rarely, as well as the analysis of the recordings may provide key information regarding the circumstances of the patient's death. This applies to both the potential impact of a defect or damage to the device in an event of the owner's death and the forensic analysis of the circumstances of death, especially when traditional post-mortem diagnostics do not provide a clear diagnosis. In addition, using the data stored on the device, it is possible to identify the corpse and precisely determine the time of death, which is crucial for the conducted expertise. Since it is a quick, cheap and widely available procedure, CIED analysis should be incorporated as a routine element of post-mortem diagnostics.

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“… 25 , 26 Ventricular arrhythmias are present at the time of death in 76% of SCD in patients implanted with an implantable cardioverter defibrillator (ICD). 27 Unlike HFrEF where most of the cases of SCD are due to malignant ventricular arrhythmias [ventricular tachycardia (VT) and ventricular fibrillation (VF)], the proportion of HFpEF patients with SCD due to malignant arrhythmias remains unknown but is probably high. 11 , 12 The mechanisms driving fatal events in HFpEF especially SCD remain elusive.…”

Section: High Morbidity and Mortality In Hfpef Including Scdmentioning

confidence: 99%

Are arrhythmias the drivers of sudden cardiac death in heart failure with preserved ejection fraction? A review

et al. 2022

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In patients with heart failure with preserved ejection fraction (HFpEF), sudden cardiac death (SCD) accounts for approximately 25–30% of all‐cause mortality and 40% of cardiovascular mortality in properly adjudicated large clinical trials. The mechanism of SCD in HFpEF remains unknown but thought to be driven by arrhythmic events. Apart from atrial fibrillation, which is prevalent in approximately 45% of HFpEF patients, the true burden of other cardiac arrhythmias in HFpEF remains undetermined. The incidence and risk of clinically significant advanced cardiac conduction disease with bradyarrhythmias and ventricular arrhythmias remain less known. Recommendations have been made for long‐term cardiac rhythm monitoring to determine the incidence of arrhythmias and clarify mechanisms and mode of death in HFpEF patients. In animal studies, spontaneous ventricular arrhythmias and SCD are significantly elevated in HFpEF animals compared with controls without heart failure. In humans, these studies are scant, with a few published small‐size studies suggesting an increased incidence of ventricular arrhythmias in HFpEF. Higher rates of clinically significant conduction disease and cardiac pacing are seen in HFpEF compared with the general population. Excepting atrial fibrillation, the predictive effect of other arrhythmias on heart failure hospitalization, all‐cause mortality, and precisely SCD remains unknown. Given the high occurrence of SCD in the HFpEF population, it could potentially become a target for therapeutic interventions if driven by arrhythmias. Studies to address these knowledge gaps are urgently warranted. In this review, we have summarized data on arrhythmias and SCD in HFpEF while highlighting avenues for future research in this area.

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Postmortem ICD interrogation in mode of death classification

Abstract: Postmortem ICD interrogation identifies 24% of "sudden" deaths to be nonarrhythmic. Postmortem device interrogation should be considered in all cases of unexplained sudden cardiac death.

Cited by 9 publications

References 33 publications

Novel ventricular tachyarrhythmia detection enhancement detects undertreated life-threatening arrhythmias

Novel ventricular tachyarrhythmia detection enhancement detects undertreated life-threatening arrhythmias

Remember by heart – the importance of post-mortem cardiac implantable electronic device analysis

Are arrhythmias the drivers of sudden cardiac death in heart failure with preserved ejection fraction? A review

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