Abstract 17838: The Critical Role of Cardiovascular Implantable Electronic Device Interrogation at Autopsy: A 5 Year Review of the Johns Hopkins Post-mortem CIED Registry
Introduction: CIED (pacemaker (PPM) or defibrillator (ICD)) analysis is recommended upon death but there is no data upon the role of systematic CIED analysis at autopsy. We undertook a registry analysis to determine the utility of pre-specified CIED explantation, interrogation and technical analysis at autopsy.
Methods: From May 19, 2009 - May 18, 2014 adult & pediatric autopsy subjects at two academic institutions underwent concomitant CIED pulse generator explantation. The autopsy report was reviewed and the CIED was interrogated by an electrophysiologist (EP) for relevant clinical alerts and submitted to the applicable manufacturer for technical analysis. Significant alerts were reviewed & confirmed by a 2nd EP.
Results: Seventy (4.3%) of 1642 autopsies had CIEDs and underwent either complete (90%) or limited autopsy. There were 30 PPMs and 40 ICDs (4 manufacturers). The mean age at death was 62.7 years (range 6 months - 97 years). In total, 35 (50%) died suddenly and 35 died non-suddenly. Significant clinical alerts were found in 22/35 (62.9%) sudden death subjects and included; 10 sustained VT/VF episodes terminated with either internal or external shocks, 10 sustained VT/VF episodes not terminated due to: undersensing (3), unsuccessful shock (2), rate below ICD therapy cut-off (1), or sustained VT/VF detection in PPM recipient (4). 4 (2 with VT/VF) exhibited an intra-thoracic impedance derived fluid index > 200. In the non-sudden death group 7/35 (20%) displayed a significant clinical alert; 2 sustained VT/VF episodes and 6 (1 with VT/VF) exhibited a fluid index > 200. There was significant association between likelihood of clinical alert and sudden death as compared to non-sudden death (χ2 = 11.538, p< 0.001) and between likelihood of clinical alert in an ICD recipient as compared to a PPM recipient (χ2 = 15.006, p< 0.001). Manufacturer analyses uncovered premature battery depletion, hard reset due to cold exposure, and did not reveal any CIED component failure contributing to death.
Conclusion: CIED analysis is an important post-mortem diagnostic tool and should be routinely performed at the time of autopsy. Post-mortem CIED analysis is especially useful in cases of sudden death to screen for significant clinical alerts and to rule out component failure.
Author Disclosures: S.K. Sinha: None. B. Crain: None. K. Flickinger: None. H. Calkins: None. J. Rickard: None. A. Cheng: None. R. Berger: None. G. Tomaselli: None. J.E. Marine: None.
- © 2014 by American Heart Association, Inc.