The clinical value of the routine analysis of cardiac implantable electronic devices after the patient's death in a tertiary cardiovascular center

Abstract

Introduction: The postmortem interrogation of cardiac implantable electronic devices (CIEDs) has not been regularly practiced yet. We presumed that it can provide data not only on the mechanism of the patient's death but also on possible device malfunctions contributing to its occurrence.

Objectives: The study aimed to determine the usefulness of the explantation and interrogation of CIEDs after the patient's death in routine clinical practice, when combined with autopsy findings and clinical follow‑up starting from the time after device implantation.

Patients and methods: Between August 24, 2008 and August 30, 2018, all patients who underwent autopsy in the tertiary cardiovascular center or partner facilities had the device explanted and interrogated by the qualified electrophysiologist. Clinical characteristics obtained at the time of device implantation and patients' death were obtained from medical records. Device interrogation results were then combined with autopsy report and clinical data.

Results: Out of 1200 autopsied patients, the device was removed and analyzed in 61 individuals. Clinical characteristics from the time of implantation and patients' death were available in 53 (86.7%) and 49 (80.3%) patients, respectively. Device‑related concerns, undetected during patients' hospital stay, were noted in 6 cases (6.1%) and included 3 programming and 3 hardware issues.

Conclusions: To our knowledge, this is the first study to date to combine the clinical follow‑up of patients before death and on admission at the end of life, autopsy results, and postmortem CIED interrogation. Having implemented the device interrogation, we found 6 CIED‑related events potentially associated with patients' death, which were not detected before its occurrence.