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<p>With the increasing use of cardiac implantable electronic devices (CIEDs), forensic pathologists are more frequently faced with their postmortem management. While medical guidelines specify implantation indications, algorithm optimization and device programming, there is no standardized protocol for their postmortem handling. Postmortem interrogation of CIEDs can provide crucial information on the cause and mechanism of death and help rule out device malfunctions. Based on two cases of sudden death implanted with a defibrillator or pacemaker and a review of the literature, the challenges faced were highlighted, including data loss due to postmortem device handling and potential conflicts of interest when the teams responsible for implantation were also involved in data retrieval. The first case was an 86-year-old woman implanted with a defibrillator who died suddenly after receiving a vaccine. The fact that CIED data were not immediately retrieved and postmortem artifacts were recorded led to memory saturation, preventing a precise correlation between the cardiac events and the cause of death. The second case was a 14-year-old adolescent implanted with a pacemaker who died of ventricular fibrillation triggered by programming modifications. The pre-autopsy CIED interrogation allowed accurately identifying the cause of death and ruling out any medical negligence. Immediate postmortem interrogation of CIEDs is essential to ensure data integrity and prevent any loss. An independent standardized protocol, such as that implemented in Strasbourg (France), would allow a reliable CIED data analysis while avoiding conflicts of interest, thus improving forensic investigations in case of sudden death.</p>

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Postmortem data collection protocol for cardiac implantable electronic devices by the forensic pathologists: how to avoid conflicts of interest and minimize data loss?

  • 期刊论文

  • 发表日期：

    2025年8月11日

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  • Sébastien Gaertner,
  • Laurent Berthelon,
  • Eric Quiring,
  • Laurence Jesel-Morel,
  • Jean-Sébastien Raul,
  • Audrey Farrugia

摘要

With the increasing use of cardiac implantable electronic devices (CIEDs), forensic pathologists are more frequently faced with their postmortem management. While medical guidelines specify implantation indications, algorithm optimization and device programming, there is no standardized protocol for their postmortem handling. Postmortem interrogation of CIEDs can provide crucial information on the cause and mechanism of death and help rule out device malfunctions. Based on two cases of sudden death implanted with a defibrillator or pacemaker and a review of the literature, the challenges faced were highlighted, including data loss due to postmortem device handling and potential conflicts of interest when the teams responsible for implantation were also involved in data retrieval. The first case was an 86-year-old woman implanted with a defibrillator who died suddenly after receiving a vaccine. The fact that CIED data were not immediately retrieved and postmortem artifacts were recorded led to memory saturation, preventing a precise correlation between the cardiac events and the cause of death. The second case was a 14-year-old adolescent implanted with a pacemaker who died of ventricular fibrillation triggered by programming modifications. The pre-autopsy CIED interrogation allowed accurately identifying the cause of death and ruling out any medical negligence. Immediate postmortem interrogation of CIEDs is essential to ensure data integrity and prevent any loss. An independent standardized protocol, such as that implemented in Strasbourg (France), would allow a reliable CIED data analysis while avoiding conflicts of interest, thus improving forensic investigations in case of sudden death.