Heart rhythm at the time of death documented by an implantable loop recorder.
OBJECTIVE
The aims of this study were to describe arrhythmias documented with an implantable loop recorder (ILR) in post-acute myocardial infarction (AMI) patients with left ventricular dysfunction at the time of death and to establish the correlation to mode of death.


RESULTS
Post-mortem ILR device interrogations were analysed from patients dying in the CARISMA study. Mode of death was classified by a modified CAST classification. Twenty-six patients died with an implanted ILR. Of these, 16 had an electrocardiogram recorded at the time of death. Ventricular tachycardia (VT)/ventricular fibrillation (VF) was terminal rhythm in eight patients and bradyarrhythmias were observed in another eight patients. Of the deaths with peri-mortem recordings, seven were classified as sudden cardiac death (SCD). In six of these, VF was documented at the time of death. Six monitored deaths were classified as non-SCD (NSCD) of which only two had recordings of VT/VF, whereas four had bradyarrhythmias. All peri-mortem recordings in non-cardiac death (NCD) were bradyarrhythmia.


CONCLUSIONS
Long-term monitoring in a population of post-AMI patients with left ventricular ejection fraction < or =40% showed that VT/VF and bradyarrhythmia each accounted for half of the recorded events at the time of death. The ILR confirmed that ventricular tachyarrhythmias are associated primarily with SCD, whereas bradyarrhythmias and electromechanical dissociation seems dominant in NSCD and NCD. The study was registered at ClinicalTrials.gov: NCT00145119.
Gang
Uffe Jakob Ortved
UJ
Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, Internal Post 4210, 2900 Hellerup, Denmark. dr.gang@dadlnet.dk
Jøns
Christian
C
Jørgensen
Rikke Mørch
RM
Abildstrøm
Steen Zabell
SZ
Haarbo
Jens
J
Messier
Marc D
MD
Huikuri
Heikki V
HV
Thomsen
Poul Erik Bloch
PE
D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D002423:Cause of Death; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*