Using CRM devices as forensic clues

Pacemakers and other cardiac rhythm management devices could help solve forensic cases by revealing a time and cause of death in cases where an autopsy is inadequate, according to a study presented today at EHRA Europace Cardiostim 2017.

Lead author Dr. Philipp Lacour said in a statement that using CRM devices as clues could help satisfy an unmet need – nearly 30% of forensic cases remain unsolved because the autopsy does not clarify the cause or time of death.

“The number of implanted cardiac devices with sophisticated diagnostic functions is increasing and we thought interrogating them might help to shed light on these unclear deaths,” Lacour said. “Currently, device interrogation is not routinely performed after autopsy.”

Lacour teamed up with the Dept. of Forensic Medicine at the Charite-Medical University of Berlin, which performed more than 5,000 autopsies in a 5-year period. Of the 5,000 cases, 150 of them involved an implantable cardiac device.

The devices included 107 pacemakers, 22 implantable cardioverter defibrillators, 14 cardiac resynchronization therapy systems and 6 implantable loop recorders.

Electrophysiologists were able to determine the time of death in 76% of cases using data from the device.

The team also reported that they could identify – to the minute – when the patient suffered tachycardia.

The researchers were able to identify the cause of death, which included things like bradycardia and device malfunctions, in 24% of cases.

“The cause of death was most easily determined when the patient had a lethal arrhythmia such as tachycardia which was documented by the device,” Lacour said. “For example a ventricular fibrillation was recorded by a pacemaker, which did not intervene because it was not a defibrillator, and showed us that this arrhythmia caused the death.”

A device malfunction, such as hardware failure or an algorithm problem, happened in 7% of cases.

“In our study, the time or cause of death was unclear in about 30% of cases after autopsy alone. This dropped to around 10-20% using device interrogation. The 2 procedures provide complementary information and with the combination we can solve around 85% of all unclear deaths,” Lacour said.

“We think device interrogation should be routinely performed after autopsy in all forensic cases. It helps determine the time and cause of death and identifies device malfunctions that might otherwise have gone unnoticed and should be highlighted to manufacturers and health departments,” he added. “To ensure that accurate data is extracted from cardiac devices, the time between autopsy and device interrogation should be kept as short as possible and we try to do it within 2 weeks. This avoids the memory of the device filling up with artefacts that can be generated after the leads are cut.”

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