Cardiovascular implantable electronic device function and longevity at autopsy: an underestimated resource

Sunil K. Sinha, Barbara Crain, Katie Flickinger, Hugh Calkins, John Rickard, Alan Cheng, Ronald Berger, Gordon F. Tomaselli, Joseph E. Marine

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background The feasibility and safety of postmortem cardiovascular implantable electronic device (CIED; pacemaker or defibrillator) retrieval for reuse has been shown. To date, studies indicate a low yield of reusable postmortem CIEDs (17%–30%). Objective The purpose of this study was to test the hypothesis that a higher rate of reusable CIEDs would be identified upon postmortem retrieval when an institutional protocol for systematic and routine acquisition, interrogation, reprogramming, and manufacturer analysis was used. Methods Over a 6-year period, all subjects referred for autopsy underwent concomitant CIED pulse generator retrieval and enrollment in the Johns Hopkins Post-Mortem CIED Registry. CIEDs were interrogated, reprogrammed, and submitted for manufacturer analysis. Results In total, 84 autopsies had CIEDs (37 pacemakers, 47 implantable cardioverter-defibrillators). CIEDs were implanted 2.84 ± 2.32 years before death, with 30% implanted <1 year before death. Overall, CIED postmortem longevity was 4.79 ± 3.41 years, with 56% demonstrating longevity ≥4 years (this group had an estimated mean longevity of 7.37 ± 2.44 years). Manufacturer analyses uncovered 2 falsely triggered elective replacement indication alerts, confirmed 5 correctly triggered elective replacement indication alerts, identified a recalled pacemaker, and verified that a defibrillator had undergone nonprogrammable hard reset. Conclusion When a protocol for systematic and routine postmortem CIED retrieval, interrogation, reprogramming, and analysis was used, we noted that >60% of pacemakers and >50% of defibrillators demonstrated normal functional status with projected longevities >7 years on average. Formation of a national hospital-based “CIED donor network” would facilitate larger scale charitable efforts in underserved countries.

Original languageEnglish (US)
Pages (from-to)1971-1976
Number of pages6
JournalHeart Rhythm
Volume13
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Keywords

  • Autopsy
  • Defibrillator
  • Defibrillator retrieval
  • Pacemaker retrieval
  • Pacemaker reuse

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Sinha, S. K., Crain, B., Flickinger, K., Calkins, H., Rickard, J., Cheng, A., Berger, R., Tomaselli, G. F., & Marine, J. E. (2016). Cardiovascular implantable electronic device function and longevity at autopsy: an underestimated resource. Heart Rhythm, 13(10), 1971-1976. https://doi.org/10.1016/j.hrthm.2016.05.023