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Postmortem interrogation of cardiac implantable electrical devices may clarify time and cause of death

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Abstract

Background

Postmortem interrogation of cardiac implantable electrical devices (CIED) in autopsy is not routinely performed. Thus, it remains unclear whether an interrogation might clarify time and cause of death.

Methods

Seventy of 4401 patients (1.6%) undergoing autopsy in 2014 and 2015 presented with a CIED. The explanted CIED were interrogated with respect to time and possible cause of death. Battery and lead parameters, clinical and technical alerts, and arrhythmia episodes were reviewed and afterwards correlated with the results of autopsy and clinical data.

Results

Twenty-five implantable cardioverter defibrillators (ICD) and 45 pacemaker (PM) devices were analyzed. Death was classified as cardiac by autopsy in 17 of 70 patients. Accordingly, presumably lethal ventricular arrhythmias were documented in six patients (8.6%; 5 ICD, 1 PM). In two of 30 patients with unknown cause of death after autopsy (6.7%), interrogation revealed ventricular tachycardia as potential reason for decease (1 ICD, 1 PM). Postmortem CIED interrogation additionally allowed to make a statement regarding the day of death in 36 patients (51%; 13 ICD, 23 PM). This was in accordance with clinical data or the results of autopsy in nine patients (25%; 3 ICD, 6 PM) or could even clarify the time of death in six patients (16.7%; 4 ICD, 2 PM).

Conclusion

Interrogation of CIED revealed potentially lethal ventricular arrhythmias in 9 of 70 patients investigated and enabled valid estimation of the day of death in 15 patients. We therefore conclude that routinely performed postmortem CIED interrogation may clarify time and cause of death.

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Author notes

  1. Lisa Riesinger and S. Fichtner contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Medizinische Klinik und Poliklinik I, University Hospital Munich, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany

    Lisa Riesinger, S. Fichtner, C. G. Schuhmann, H. L. Estner, T. Czermak & K. Lackermair

  2. Ludwig-Maximilians University Munich, Institute of Forensic Medicine, Munich, Germany

    M. Graw & F. Fischer

Authors
  1. Lisa Riesinger
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  2. S. Fichtner
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  3. C. G. Schuhmann
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  4. H. L. Estner
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  5. T. Czermak
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  6. M. Graw
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  7. F. Fischer
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  8. K. Lackermair
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Corresponding author

Correspondence to Lisa Riesinger.

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Data collection and documentation was performed anonymously and with permission of the ethics committee of the Ludwig-Maximilians University.

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Riesinger, L., Fichtner, S., Schuhmann, C.G. et al. Postmortem interrogation of cardiac implantable electrical devices may clarify time and cause of death. Int J Legal Med 133, 883–888 (2019). https://doi.org/10.1007/s00414-018-1932-3

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  • DOI: https://doi.org/10.1007/s00414-018-1932-3

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