Abstract 2878: Feasibility of Post-Mortem Device Interrogation for Detection of Terminal Arrhythmias and/or Device Failure
Introduction: Pacemaker (PM) and ICD failures have been reported at alarming rates and implicated in pt deaths, yet the frequency of association with mortality remains unknown. Device investigation in the living may under-represent these rates. We sought to determine if terminal arrhythmias were detected or treated and whether device failure occurred by interrogating devices explanted at autopsy.
Methods: We interrogated all devices explanted at autopsy over a 10 yr period at our institution. Primary endpoints were number of arrhythmic episodes on the day of death and within 2 weeks of death, detection of significant changes in lead parameters, and occurrence of post-mortem artifact.
Results: Eighty-one devices (61 PMs, 20 ICDs) from 6 companies were examined. Successful interrogations were performed in 36 PMs (59%) and 14 ICDs (70%). Complete data relating to device therapy, medical records, and autopsy reports were obtainable in 14 PMs (23%) and 11 ICDs (55%). Mean time from implantation until death was 2.0±2.3 yrs (range of 63–2482 days) and 1.4±0.8 yrs (range of 89 –1063 days) for PMs and ICDs respectively. Mean time from explantation until interrogation was 3±2.4 yrs (range 0.4 –10 yrs). On the day of death, arrhythmic episodes were recorded in 2 PMs (1 with VT, 1 with atrial tachycardia/atrial fibrillation (AT/AF)) (3.3%) and 4 ICDs (2 with VT, 1 with ventricular fibrillation (VF), 1 with AT/AF) (20%). Within 2 weeks of death, arrhythmic episodes were recorded in 7 PMs (5 with VT, 2 AT/AF) (11.5%) and 7 ICDs (2 with VT, 2 VF, 3 AT/AF) (35%). One PM detected a lead fracture of unclear clinical significance 1 day prior to pt’s death. Interestingly 1 death certificate listed VT as cause of death yet the PM failed to detect any high rate episodes that day. Events attributed to electromagnetic interference post-mortem were noted in 18 devices (22%), 10 of which (12%) were confirmed to occur during autopsy. All of these events were successfully categorized as artifact by an investigator blinded to the date of death.
Conclusion: It is feasible to extract data regarding terminal arrhythmias and device function from ICDs and PMs post-mortem many yrs after death. These data may be useful in better determining device failure rates and their association with pt death.