Why We Need Postmortem Analysis of Cardiac Implantable Electronic Devices

Abstract

The prevalence of cardiac implantable electronic devices (CIEDs), pacemakers and implantable cardioverter defibrillators (ICDs) is increasing. However, postmortem analysis of CIEDs is not performed routinely. Fourteen consecutive CIEDs were analyzed. The indication for and date of implantation, technical data, CIED reprogramming, heart rhythm disturbances, patient demographics and medical consultations were investigated. Death during the first year after implantation was seen in 54%, whereof 71% consulted a physician within 10 days before death. The time of death was attributed to a particular day in 29%. There was a relationship between CIEDs and cause/manner of death in 50%. Although limited by a small sample size, this study advocates the routine postmortem CIED analysis for forensic and clinical purposes in selected cases. Patients with CIEDs seem to show an increased risk of death during the first year after implantation. The analysis of CIEDs can be helpful in evaluating the time/cause/manner of death.

Entomological and Cardiologic Evidence of Time Since Death in Short Postmortem Intervals

“…Additionally, postmortem investigation of pacemakers is infrequently used in forensic pathology to date. Recent research indicates benefits of pacemaker reading in solving causes and noting time of death in around two‐thirds of all cases, irrespective of the putrefaction stage of the deceased . In the presented case, witness testimonies were contradictory regarding the time interval of a missing person between approximately 2 days and less than 1 day.…”

Commentary on: Mauf S, Jentzsch T, Laberke PJ, Thali MJ, Bartsch C. Why we need postmortem analysis of cardiac implantable electronic devices. J Forensic Sci 2016;61(4):988–92.

“…We read with interest the recent article by Mauf and colleagues, "Why We Need Postmortem Analysis of Cardiac Implantable Electronic Devices." (1) As you may be aware, we recently published the first systematic complete evaluation of every incident sudden death in San Francisco County over a 2-year period with a CIED as part of the NIH-funded POST SCD (POstmortem Systematic invesTigation of Sudden Cardiac Death) study, a unique multidisciplinary collaboration between forensic pathology, cardiac pathology, epidemiology, and cardiac electrophysiology, which included 22 CIEDs (2). We found that half of these lethal events had cardiac device problems, nearly all of which were never reported in the FDA's MAUDE (Manufacturer and User Utility Device Experience) database.…”

“…We read with interest the recent article by Mauf and colleagues, “Why We Need Postmortem Analysis of Cardiac Implantable Electronic Devices.”…”

Forensic cardiac device analysis at the Los Angeles County Department of the Coroner: A 20‐year experience

“…As long as the battery is not depleted, those devices keep functioning even after the patient's death, and retrieving their logs remains possible. Although postmortem analysis of CIEDs has not yet become a common practice, these device logs may contain precious information about the patient's terminal event and may aid forensic professionals in clarifying the circumstances of death, particularly when these circumstances are questionable [6].…”