title: Cardiovascular implantable electronic device function and longevity at autopsy: an underestimated resource.
abstract: The feasibility and safety of postmortem cardiovascular implantable electronic device (CIED; pacemaker or defibrillator) retrieval for reuse has been shown. To date, studies indicate a low yield of reusable postmortem CIEDs (17%-30%).
  
  
  
  The purpose of this study was to test the hypothesis that a higher rate of reusable CIEDs would be identified upon postmortem retrieval when an institutional protocol for systematic and routine acquisition, interrogation, reprogramming, and manufacturer analysis was used.
  
  
  
  Over a 6-year period, all subjects referred for autopsy underwent concomitant CIED pulse generator retrieval and enrollment in the Johns Hopkins Post-Mortem CIED Registry. CIEDs were interrogated, reprogrammed, and submitted for manufacturer analysis.
  
  
  
  In total, 84 autopsies had CIEDs (37 pacemakers, 47 implantable cardioverter-defibrillators). CIEDs were implanted 2.84 ± 2.32 years before death, with 30% implanted <1 year before death. Overall, CIED postmortem longevity was 4.79 ± 3.41 years, with 56% demonstrating longevity ≥4 years (this group had an estimated mean longevity of 7.37 ± 2.44 years). Manufacturer analyses uncovered 2 falsely triggered elective replacement indication alerts, confirmed 5 correctly triggered elective replacement indication alerts, identified a recalled pacemaker, and verified that a defibrillator had undergone nonprogrammable hard reset.
  
  
  
  When a protocol for systematic and routine postmortem CIED retrieval, interrogation, reprogramming, and analysis was used, we noted that >60% of pacemakers and >50% of defibrillators demonstrated normal functional status with projected longevities >7 years on average. Formation of a national hospital-based "CIED donor network" would facilitate larger scale charitable efforts in underserved countries.
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: sunilsinha@jhmi.edu.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Sinha
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Crain
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Katie
authors.initials: K
authors.lastname: Flickinger
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Gordon
authors.initials: G
authors.lastname: Tomaselli
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
mesh_terms: D001344:Autopsy; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D017743:Equipment Reuse / Q000706:statistics & numerical data*; D006801:Humans; D008422:Materials Testing / Q000379:methods / Q000706:statistics & numerical data; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D014481:United States
keywords: Autopsy; Defibrillator; Defibrillator retrieval; Pacemaker retrieval; Pacemaker reuse