Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Am Coll Cardiol. 2016 Sep 20;68(12):1255-64. doi: 10.1016/j.jacc.2016.06.052.
Cardiovascular implantable electronic device (CIED) removal and interrogation are recommended at autopsy in suspected cases of sudden cardiac death, but data on the role of nonselective post-mortem CIED (pacemaker or defibrillator) analysis in this setting are lacking.
This study undertook an institutional registry analysis to determine the utility of systematic routine CIED removal, interrogation, and analysis at autopsy.
From May 19, 2009, to May 18, 2015, autopsy subjects with a CIED at a Johns Hopkins University medical institution (Baltimore, Maryland) underwent CIED removal and interrogation by an electrophysiologist for clinical alerts. The CIED was then submitted for technical analysis by the manufacturer. The CIED interrogation, the manufacturer's technical analysis, and the final autopsy report were all cataloged in the Johns Hopkins Post-mortem CIED Registry.
A total of 2,025 autopsies were performed; 84 subjects had CIEDs removed and analyzed. These devices included 37 pacemakers and 47 defibrillators. Overall, 43 subjects had died suddenly, and 41 had not died suddenly. Significant clinical alerts (sustained tachyarrhythmias or an elevated fluid index value) were seen in 62.8% cases of sudden deaths. In the nonsudden death cohort, 19.5% displayed a significant clinical alert. Significant association of CIED alerts were noted when comparing sudden deaths versus nonsudden deaths (p < 0.001), defibrillators versus pacemakers (p < 0.005), and cardiac versus noncardiac causes of death (p < 0.001). Manufacturer analyses revealed a case of premature pacemaker battery depletion, as well as a hard reset in a defibrillator as a result of cold exposure.
Post-mortem CIED analysis was clinically useful in assisting with determination of the timing, mechanism, and cause of death in the majority of sudden deaths and in almost 20% of nonsudden deaths. The authors advocate CIED removal with analysis as an important diagnostic tool in all autopsies and to assist manufacturers in identifying potentially fatal device failures.
在疑似心源性猝死的病例中，建议在尸检时取出并检查心血管植入式电子设备（CIED），但目前尚缺乏在这种情况下非选择性死后 CIED（起搏器或除颤器）分析作用的数据。
本研究通过机构注册分析，确定系统常规 CIED 取出、检查和尸检分析的实用性。
从 2009 年 5 月 19 日至 2015 年 5 月 18 日，在马里兰州巴尔的摩市的约翰霍普金斯大学医疗机构进行尸检的 CIED 患者由电生理学家进行 CIED 取出和检查，以获取临床警报。然后，制造商对 CIED 进行技术分析。制造商的技术分析、CIED 检查和最终尸检报告均被列入约翰霍普金斯死后 CIED 登记处。
共进行了 2025 次尸检，其中 84 例患者取出并分析了 CIED。这些设备包括 37 个起搏器和 47 个除颤器。总的来说，43 名患者突然死亡，41 名患者没有突然死亡。在突然死亡病例中，62.8%有明显的临床警报（持续性快速性心律失常或液体指数值升高）。在非突然死亡组中，19.5%有明显的临床警报。在将突然死亡与非突然死亡进行比较时，注意到 CIED 警报有显著关联（p<0.001），在比较除颤器与起搏器（p<0.005）以及心源性与非心源性死亡原因（p<0.001）时，也有显著关联。制造商的分析显示了一个起搏器电池过早耗尽的病例，以及一个除颤器因暴露在寒冷中而硬重置的病例。
在大多数突然死亡病例中，尸检 CIED 分析在协助确定死亡时间、机制和原因方面具有临床意义，在近 20%的非突然死亡病例中也具有临床意义。作者主张在所有尸检中取出并分析 CIED，作为一种重要的诊断工具，并协助制造商识别潜在致命的设备故障。
