Remotely Monitored Death of a Patient with Implanted ICD (original) (raw)
Related papers
Journal of Interventional Cardiology, 1994
Clinical factors and terminal events associated with sudden death in 51 patients were analyzed from among a multicenter experience of 864 recipients of first generation automatic implantable cardioverter defibrillator (AICD ") devices (single zone, committed, monophasic pulse with ->I epicardial patch electrode) during the period May 1982-February 1988. For these 51 patients, mean age was 58 years and atherosclerotic heart disease was present in 84%, with a history of ventricular fibrillation (VF) in 61%, and inducible sustained ventricular tachycardia (VT) in 84%; mean left ventricular ejection fraction was 0.26. Nearly 80% experienced one or more appropriate AICD'" shocks during the median 9 month (range 0-46 months) period prior to death.
“Natural death” of a patient with a deactivated implantable-cardioverter-defibrillator (ICD)?
Forensic Science International, 2002
A 66-year-old patient with terminal heart insufficiency (NYHA IV) received maximum medical therapy, but was also in need of an implantable-cardioverter-defibrillator (ICD). The ICD functioned flawlessly for the whole duration of implantation. It reverted several ventricular tachycardias with anti-tachycardial pacing alone, whereas some needed cardioversion as well. The patient died on the fourth day of hospitalization for a routine check of his ICD. The post-mortem examination revealed, that the ICD was deactivated and that the data had been erased after the patient's death. By reading off the raw data still stored within the ICD, the erased information could be restored. The stored EGMs showed traces of old ICD interventions as well as a permanent deactivation provoked by exposition to a magnetic field just hours before the patient's death. The problem of archiving and documenting the volatile electronic data inside the ICD is discussed. The need of a full autopsy after telemetric reading of the ICD data, including the explantation of the ICD aggregate and electrodes, as a means of quality assurance and under forensic aspects is emphasized.
Journal of the American College of Cardiology, 2018
Background: Ventricular tachyarrhythmia is the usual cause of sudden unexpected death (SUD) in cardiac patients lacking an implanted cardiac defibrillator (ICD). However, the mechanism of SUD is not fully elucidated in patients with an ICD in place to remedy ventricular tachycardia (VT) or ventricular fibrillation (VF). Methods: MADIT-CRT was a randomized trial of 1820 patients with ischemic or non-ischemic cardiomyopathy comparing ICD alone to ICD with added resynchronization. When deaths occurred, available clinical and electrocardiographic data were assembled and systematically assessed by a Mortality Evaluation Review Committee. In the current analysis, all 35 post-mortem device interrogations were reviewed among the 191 decedents of the MADIT-CRT Trial. SUD (patient died < 3 hours from symptom onset or patient found dead <3 days after last seen alive) occurred in 24 of these interrogated patients. SUD also occurred in 15 patients without post-mortem interrogation. Results: 11 of 24 with SUD and post-mortem interrogation had fatal VT/VF: 6 had unsatisfactory ICD performance (inappropriate shock initiating VT/VF in 2 and failure to detect low-amplitude and/or slow VF in 4); 4 had refractory or rapidly recurrent VT/VF; 1 had refractory bradycardia. The remaining 13 patients with SUD had no tachyarrhythmia initiating device activation. Autopsy in 3 of these patients disclosed only scattered myocardial fibrosis with no acute pathological changes. No clinical features or event history discriminated 11 interrogated SUD patients with tachyarrhythmia from the 13 without tachyarrhythmia Conclusion: 1) Spontaneous refractory VT/VF was the cause of SUD in only a minority (17%) of patients previously receiving an ICD in conjunction with the MADIT-CRT Trial. 2) No arrhythmia was identified in a majority (54%), indicating preponderant mechanisms of SUD other than tachyarrhythmia in patients with an ICD. 3) ICD-related pro-arrhythmia occurred in at least two cases and is an important cause of SUD in this population. Post-mortem device interrogation is helpful and should be encouraged in decedents with ICD, particularly individuals participating in investigations of cardiovascular therapies.
Mechanisms of Inappropriate Defibrillator Therapy in a Modern Cohort of Remotely Monitored Patients
Pacing and Clinical Electrophysiology, 2013
Introduction: Defibrillator (ICD) technology and monitoring are evolving rapidly. We investigated the mechanisms of inappropriate ICD therapies in a modern cohort of patients followed at our institution via remote monitoring. Methods: From September 2009 to March 2011, a total of 2,050 ICD patients (19,600 patient-months) were remotely followed. All events (shocks and antitachycardia pacing) were adjudicated by arrhythmia specialists. Results: A total of 249 patients received ICD therapy (34% inappropriate therapy). Inappropriate ICD shocks affected 33 (1.6%) patients. There were a total of 249 inappropriate episodes in 85 patients. Supraventricular tachycardia (SVT) with 1:1 atrioventricular association was the predominant mechanism accounting for 133 episodes in 50 patients, followed by atrial fibrillation (97 episodes in 27 patients). T-wave oversensing (16 episodes in five patients), electromagnetic interference (two episodes in two patients), and ectopic beats (one episode in one patient) accounted for a small proportion of events. There were 35 arrhythmic episodes in five patients that could not be classified, all in patients with single-chamber devices. There were no differences in these results by device manufacturer.
Implantable Defibrillation: Eight Years Clinical Experience
Pacing and Clinical Electrophysiology, 1988
THOMAS, A.C., ET AL.: Implantable defibrillation: eight years clinical experience. Implantation of the first automatic de/ibriJIator occurred in February 1980. Incorporation o/cardioversion capability in 1982 resulted in the AICD^^ automatic implantabJe cardioverter de^briJJator. Between April 1, 1982 and April 15, 1988, 3610 patients in 236 U.S. and 84 international centers received AICD pulse generators. Patient population consisted of 2904 males and 683 females with recurrent ventricular tachycardia and/or fibrillation, mean age 59 yrs. (range 9-96 yrs.). Primary diagnoses reported for the patient group were: coronary artery disease (63.5%), nonischemic cardiomyopathy (12.9%), other (6.4%) and unspecified {17.2%). Mean reported LV ejection paction was 32.8%. Follow-up averaged 12.2 mo. (range 0-72 mo.). Of 385 deaths, 94 (24%) were sudden. Cumulative percentage survival (±S.E.) from sudden cardiac death (SCD) was 98.0 ± 0.3%, 96.5 ± 0.5%, 95.2 ± 0. 7%, 93.7 ± 1.0%, 93.7 ± 1.0% and 89.7 ± 4.0% at 12, 24, 36, 48, 60 and 72 months, respectively. Operative mortality {^30 days) was 2.5%. Reported side e^ects/compJications were similar to those o/pacemakers. To date, 33% of the patients received spontaneous device countershocks. AICD pulse generator survival from electrical and mechanical failures was 92.8 ± 0. 5%, 88.4 ± 0.7%, 86.7 ± 0.8% and 86.4 ± 0.9% at 12, 18, 24 and 30 mos. Data analysis demonstrates that the AICD has had a significant impact on patient survival from SCD. (PACE, Vol. 11, November Part II1988) automatic impJantabJe cardioverter dejibriJJator, ventricuJar tachyarrhythmias, dejibriJJation techniques
Mechanism of death in patients with the automatic implantable cardioverter defibrillator
Pacing and clinical electrophysiology : PACE, 1988
Fifty patients underwent primary implantation of an automatic implantable cardioverter defibrillator between August 1983 and April 1988 and were entered into a long-term surveillance program. There were a total of 14 deaths (28%) in the entire group occurring at a mean of 8.7 months postimplantation. Eleven deaths were cardiac and three were noncardiac (two pneumonia, one leukemia). The group of deceased patients were similar to the survivors in all respects except for a statistically lower ejection fraction (23% vs 32%) at the time of implantation. In addition, 13/14 (93%) of the deceased patients experienced at least one appropriate AICD discharge at a mean of 4.5 months post implantation. Recorded ECGs at the time of death revealed that most of the sudden deaths were due to electromechanical dissociation and not to AICD-treatable arrhythmias. These data suggest therefore that death in AICD patients is usually cardiac, due primarily to low ejection fraction and occurs in patients ...
Analysis of Deaths in Patients with an Implantable Cardioverter Defibrillator
Pacing and Clinical Electrophysiology, 1992
EDEL, T.B., ET AL.: Analysis of Deaths in Patients with an Implantable Cardioverter Defibriiiator. The cause of death and clinical characteristics of 26 potients Ihat died a/terimpiantabJe cardioverter de/ibriJ-latoT pJacement were reviewed and compared to the 145 patients still Jiving after a mean follow-up of 17 months. Operative mortality was 4% (7/171) and resulted from postoperative ventricuJar arrhythmias (four patients), heart failure (two patients), and respiratory failure (one patient). Operative mortality was significantly higher (1.7% vs 9.6%, P < 0.05) following concomitant surgical procedures. Total late mortality was 11% (181171). Thirteen deaths (75%) occurred in-hospital/rom progressive deterioration of left ventricuiar function (nine patients], arrhythmia flvvo patients], and noncardiac causes (two patients]. Outpatient mortality ivas 3.5% (6/171] and resulted from presumed sudden cardiac death in five of six patients; two of the five had devices that were inactive, one had high defibrillation thresholds, and two had suspected bradyarrhytiimic deaths. One postoperative death and one late in-hospitaJ death were aiso considered sudden cardiac deaths for a total of seven patients with defibriUation system failures. By muitivariant analysis, preoperative clinical characteristics associated with a worse prognosis following defibrillator impJantation were identified: presentation as ventricular tachycardia (P < 0.02], induction of sustained monomorphic ventricular tachycardia (P < 0.05), poor left ventricular performance (P < 0.01 J, poor functional status (P < 0.001), and the use of diuretics (P < 0.01). Frequent device discharges (P < 0.001J and concomitant antitachycardia pacing systems (P< 0.001] were markers for greater arrhythmia recurrence and were potent predictors of a ivorse prognosis and particularly sudden death. (PACE, Voi. 35, January 1992)
Remote Interrogation and Monitoring of Implantable Cardioverter Defibrillators
Journal of Interventional Cardiac Electrophysiology, 2000
Context: The rate of ICD implantation of has grown substantially after results of primary and secondary prevention trials have demonstrated mortality superiority over pharmacologic therapy. Although transtelephonic monitoring is routine for pacemaker follow-up there is no systematically collected data supporting remote interrogation and monitoring (RIM) of ICD patients.