Implanted Devices May Help Determine Time and Cause of Death When Autopsy Falls Short

Pacemakers can potentially help coroners get answers about the cause and time of death in certain circumstances when autopsy is unable to do so, a new study suggests.

Results presented this week at the EHRA EUROPACE-CARDIOSTIM 2017 meeting in Vienna, Austria, are important given that “in forensic medicine around 30% of cases remain unsolved because the cause or time of death after autopsy remains unclear,” Philipp Lacour, MD (Charité - Medical University of Berlin, Germany), said in a press release. “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.”

Lacour and colleagues looked at data from 150 patients autopsied at their institution between January 2012 and October 2016 who had cardiac implantable devices including pacemakers, implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT) systems, and event recorders.

Time of death could not be determined by standard forensic methods in about one-quarter of the cohort, but of those, the researchers were able to use data from the devices to pinpoint exact time of death in 36.8% of cases and time of death within a matter of days in the approximately the same proportion.

Similarly, cause of death was ruled cardiogenic among 24.7% and unclear in 9.3%. Of these, 19.6% were able to be ruled cardiac, 9.8% device-related, and 31.4% noncardiac with data from the devices.

“Are cardiologists the better coroners?” Lacour asked in his presentation. “Probably not, but postmortem [device] interrogation assists in the determination of timing, mechanism, and cause of death [and] should be done in all subjects undergoing forensic autopsy.”

Call for Cooperation

In an interview with TCTMD, Lacour said his team’s motivation for the study came from the fact that many pathology researchers have looked what happens with implanted devices after death “but nobody has ever really [done] research on forensic medicine” with regard to them.

Knowing the exact cause and time of death would have direct forensic implications, for example, in the case of determining cause in a car accident if the driver had a heart attack or in the case of murder if authorities needed to know if the victim died how and when they suspect that occurred, he explained.

Using evidence like this outside of a clinical setting would not be a first. Information from one man’s pacemaker ended up resulting in arson charges after the data were obtained by police and reviewed by a cardiologist. The man had told police he’d fled a burning house in a panic, but his pacemaker told a different story.

Ultimately, Lacour said he hopes the study will encourage cooperation between departments of cardiology and forensic medicine. “A lot of departments . . . just don't cooperate, and this could help especially in unclear cases,” he observed. Because of the intricacies in interpreting data from cardiac devices, “you need somebody . . . really trained to read out the devices.”