The clinical value of routine analysis of cardiac implantable electronic devices after death in the tertiary cardiovascular centre

INTRODUCTION Post-mortem interrogation of cardiac implantable electronic devices (CIED) is not regularly practised. We presumed that it can provide data not only about the mechanism of the patient's death but also possible malfunctions contributing to the death of the patient. OBJECTIVES The study aimed to determine the utility of explantation and interrogation of CIEDs after death, combined with autopsy findings and clinical follow-up from the period after implantation, implemented in routine clinical practice. PATIENTS AND METHODS Between 24 August 2008 and 30 August 2018, all subjects who underwent autopsy in the tertiary cardiovascular centre or partner facilities, had the device explanted and interrogated by the qualified electrophysiologist. Clinical characteristics from the time of implantation and death were imported from the patients' records. Device interrogation results were then combined with autopsy report and clinical data. RESULTS Out of 1200 autopsies performed, there were 61 patients in whom the device was removed and analyzed. Clinical characteristics from the time of implantation and death were available in respectively 53 (86.7%) and 49 (80.3%) patients. Device concerns, undetected during hospital stay were discovered in 6 cases including 3 programming and 3 hardware issues. CONCLUSIONS To our knowledge, our study is the first to date to combine clinical follow-up of patients before death and on admission at the end of life, autopsy results and post-mortem CIED interrogation. Thanks to the addition of device interrogation we have found six CIED-related events potentially associated with death, which were not discovered before death.