title: Sudden Death in Patients With Cardiac Implantable Electronic Devices.
abstract: OBJECTIVE
  Interrogations and autopsies of sudden deaths with cardiac implantable electronic devices (CIEDs) are rarely performed. Therefore, causes of sudden deaths with these devices and the incidence of device failure are unknown.
  
  
  OBJECTIVE
  To determine causes of death in individuals with CIEDs in a prospective autopsy study of all sudden deaths over 35 months as part of the San Francisco, California, Postmortem Systematic Investigation of Sudden Cardiac Death (POST SCD) study.
  
  
  METHODS
  Full autopsy, toxicology, histology, and device interrogation were performed on incident sudden cardiac deaths with pacemakers or implantable cardioverter defibrillators (ICDs). The setting was the Office of the Chief Medical Examiner, City and County of San Francisco. Participants included all sudden deaths captured through active surveillance of all deaths reported to the medical examiner and San Francisco residents with an ICD (January 1, 2011, to November 30, 2013).
  
  
  METHODS
  Identification of a device concern in sudden deaths with CIEDs, including hardware failures, device algorithm issues, device programming issues, and improper device selection. For the ICD population, outcomes were the cumulative incidence of death and sudden cardiac death and the proportion of deaths with an ICD concern.
  
  
  RESULTS
  Twenty-two of 517 sudden deaths (4.3%) had CIEDs, and autopsy revealed a noncardiac cause of death in 6. Six of 14 pacemaker sudden deaths and 7 of 8 ICD sudden deaths died of ventricular tachycardia or ventricular fibrillation. Device concerns were identified in half (4 pacemakers and 7 ICDs), including 3 hardware failures contributing directly to death (1 rapid battery depletion with a sudden drop in pacing output and 2 lead fractures), 5 ICDs with ventricular fibrillation undersensing, 1 ICD with ventricular tachycardia missed due to programming, 1 improper device selection, and a pacemaker-dependent patient with pneumonia and concern about lead fracture. Of 712 San Francisco residents with an ICD during the study period, 109 died (15.3% cumulative 35-month incidence of death), and the 7 ICD concerns represent 6.4% of all ICD deaths.
  
  
  CONCLUSIONS
  Systematic interrogation and autopsy of sudden deaths in one city identified concerns about CIED function that might otherwise not have been observed. Current passive surveillance efforts may underestimate device malfunction. These methods can provide unbiased data regarding causes of sudden death in individuals with CIEDs and improve surveillance for CIED problems.
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco.
authors.forename: Zian H
authors.initials: ZH
authors.lastname: Tseng
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hayward
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco.
authors.forename: Nina M
authors.initials: NM
authors.lastname: Clark
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Mulvanny
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Colburn
authors.affiliation: Department of Pathology, University of California, San Francisco.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Ursell
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Olgin
authors.affiliation: Office of the Chief Medical Examiner, City and County of San Francisco, San Francisco, California.
authors.forename: Amy P
authors.initials: AP
authors.lastname: Hart
authors.affiliation: Office of the Chief Medical Examiner, City and County of San Francisco, San Francisco, California.
authors.forename: Ellen
authors.initials: E
authors.lastname: Moffatt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D058409:Cardiac Resynchronization Therapy Devices; D002423:Cause of Death; D003645:Death, Sudden / Q000209:etiology*; D016757:Death, Sudden, Cardiac; D017147:Defibrillators, Implantable; D004868:Equipment Failure; D005260:Female; D016489:Head Injuries, Closed / Q000401:mortality; D006470:Hemorrhage / Q000401:mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000401:mortality*; D008171:Lung Diseases / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011014:Pneumonia / Q000401:mortality*; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000401:mortality*; D014693:Ventricular Fibrillation / Q000401:mortality*; D055815:Young Adult