Autopsy and clinical context in deceased patients with implanted pacemakers and defibrillators: intracardiac findings near their leads and electrodes.
OBJECTIVE
To evaluate intracardiac findings near leads and causes of death in pacemaker/defibrillator patients.


RESULTS
Special autopsy was performed on 78 patients deceased in a hospital. Age at death was 77.9 +/- 10.0, implantation-death interval 4.0 +/- 3.3 years, ventricular leads n = 78, and atrial leads n = 21. Thrombi along leads in brachiocephalic vein/upper caval vein (BV/UCV) were found in 22 (7), in right atrium (RA) in 11 (8), and in right ventricle (RV) in 11 cases. Bipolar lead rings were fixed by fibrous tissue in 43 (4) cases. Connective tissue bridges and tunnels were found in BV/UCV in 44 (13), in RA in 17 (15), and in RV in 68 cases, with a length of 0.2-12.0 cm. Right ventricular leads in tricuspidal orifice were fixed by fibrous tissue in 11 and penetrating chordae in 25 cases. Main causes of death were: heart failure in 35, pulmonary embolism in 9, and myocardial infarction in 11 cases.


CONCLUSIONS
We have found (i) thrombi on ventricular/atrial leads in 33/48%, (ii) bipolar lead rings fixed by fibrous tissue in 68/22%, (iii) connective tissue bridges or tunnels in ventricle/atrium in 87/71%, and (iv) ventricular leads fixed to valve or penetrating chordae in 46% of patients. We do recommend caution when extracting leads.
Novak
Miroslav
M
St Ann University Hospital, Masaryk University, Pekarska 53, Brno 65691, Czech Republic. miroslav.novak@fnusa.cz
Dvorak
Petr
P
Kamaryt
Pavel
P
Slana
Bronislava
B
Lipoldova
Jolana
J
D000368:Aged; D001344:Autopsy / Q000706:statistics & numerical data; D002304:Cardiac Pacing, Artificial / Q000401:mortality* / Q000706:statistics & numerical data; D015897:Comorbidity; D018153:Czech Republic / Q000453:epidemiology; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000295:instrumentation / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006335:Heart Injuries / Q000401:mortality*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011475:Prosthesis Failure; D013927:Thrombosis / Q000401:mortality*; D014950:Wounds, Penetrating / Q000401:mortality*