Cardiac devices could help identify cause, time of death in forensic cases

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 - autopsy

According to a new study, pacemakers and other cardiac devices could help solve forensic cases by revealing a person’s time and cause of death where an autopsy can’t.

The research was presented June 20 at the Europace Cardiostim 2017, an annual conference in Vienna, Austria, hosted by the European Society of Cardiology. The study was conducted by cardiologists at Charité Medical University in Berlin, Germany, where more than 5,000 autopsies were performed over five years. Of them, 150 had an implantable cardiac device.

The devices included 107 pacemakers, 22 implantable cardioverter defibrillators (ICDs), 14 cardiac resynchronization therapy (CRT) devices, and six implantable loop recorders.

"In forensic medicine, around 30 percent of cases remain unsolved because the cause or time of death after autopsy remains unclear," said lead author Philipp Lacour, MD, a cardiologist at Charité, in a statement. "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. Currently, device interrogation is not routinely performed after autopsy."

The exact time of death could be determined in 76 percent of the cases based on data from the devices. Cause of death was only determined in 24 percent of the cases, but showed that patients died of bradycardia, tachycardia, ventricular fibrillation and device malfunctions, which  occurred in 7 percent of the patients, including problems like broken leads and algorithm or programming issues.

"At the end of life, lead impedance rises because of changes in the heart muscle and pacing climbs to 100% because the device doesn't detect any heart rhythm,” Lacour said. “The cause of death was most easily determined when the patient had a lethal arrhythmia such as tachycardia which was documented by the device. 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."

Since the results of the study show how helpful implantable cardiac devices can be to the autopsy process, Lacour is advocating for them to become a standard process among pathologists.

"We think device interrogation should be routinely performed after autopsy in all forensic cases," he said. "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."