Key result
Post-mortem analysis of pacemakers from patients dying suddenly revealed that 89% (17/19) experienced a terminal tachycardia, most likely ventricular tachycardia, at the time of death.
Observational (n=19)
Post-mortem interrogation of pacemakers in patients who died suddenly revealed that tachycardias, likely ventricular tachycardia, are the most common terminal event.
Terminal VT may predominate in paced sudden deaths; hypothesis-generating and should not yet change practice.
AIMS: Stored electrograms or marker channels are available in most of modern cardiac pacemaker models. We sought to analyse these information to uncover terminal events of pacemaker patients dying suddenly. Method and results We made post-mortem pacemaker (PM) interrogations in 19 patients dying suddenly out of hospital between the years 1997 and 2005 (mean age 59 +/- 13 years, 90% males). The systems had activated arrhythmia monitoring algorithms. Indications of pacing were sick sinus syndrome in seven, AV-block in five, and heart failure due to asynchrony in seven cases. The interrogated pacemakers were CHORUS 7034 (n = 12), CONTAK TR (n = 2), and INSYNC III (n = 5). For interpretation stored marker channels and electrograms were analysed. The mean observation time after PM implantation prior death was 2.11 +/- 1.44 years, the mean left ventricular ejection fraction from the last available echo examination in the year prior death was 27.5 +/- 8%, mean age was 63 +/- 12 years. In 17/19 cases (89%), a tachycardia (most likely ventricular tachycardia) was found correlating to the time of death. The mean cycle length of the terminal arrhythmia was 307 +/- 144 (250-344) ms, corresponding to a heart rate of 195 +/- 95 (174-240) bpm. We found no evidence of specific pacemaker-related problems such as electronic failure, battery depletion, or undersensing. CONCLUSIONS: Post-mortem analysis of arrhythmia monitoring of pacemaker patients revealed tachycardias (most likely ventricular tachycardia) to be related to sudden death. These findings give some insight in mechanisms of terminal events in this group.
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Nägele et al. (2007) conducted an observational in Sudden death in pacemaker patients (n=19). Sudden death out of hospital was evaluated on Tachycardia correlating to the time of death. Post-mortem analysis of pacemakers from patients dying suddenly revealed that 89% (17/19) experienced a terminal tachycardia, most likely ventricular tachycardia, at the time of death.
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