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Lackermair K, Fischer F, Manhart J, Scheurer E, Graw M, Boy D, Lenz C, Hartrampf B, Kellnar A, Sams L, Estner H, Fichtner S. Determination of time of death by blinded post-mortem interrogation of cardiac implantable electrical devices. Sci Rep 2022; 12:8199. [PMID: 35581374 PMCID: PMC9112646 DOI: 10.1038/s41598-022-12390-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/29/2022] [Indexed: 12/02/2022] Open
Abstract
Postmortal interrogation of cardiac implantable electrical devices (CIED) may contribute to the determination of time of death in forensic medicine. Recent studies aimed to improve estimation of time of death by combining findings from autopsy, CIED interrogation and patients´ medical history. CIED from deceased undergoing forensic autopsy were included, if time of death remained unclear after forensic assessment. CIED explanted from deceased with known time of death were analysed as a control cohort. CIED were sent to our device interrogation lab and underwent analysis blinded for autopsy findings, medical history and police reports. The accuracy of time of death determination and the accuracy of time of death in the control cohort served as primary outcome. A total of 87 CIED were analysed. The determination of time of death was possible in 54 CIED (62%, CI 52–72%). The accuracy of the estimated time of death was 92.3% in the control cohort. Certain CIED type and manufacturers were associated with more successful determination. Blinded postmortal analysis enables a valid determination of the time of death in the majority of CIED. Analysis of explanted CIED in a cardiological core lab is feasible and should be implemented in forensic medicine.
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Affiliation(s)
- Korbinian Lackermair
- Department of Medicine I, University Hospital Munich, Ludwig Maximilian University, Marchioninistr. 15, 81377, Munich, Germany.
| | - Florian Fischer
- Institute of Legal Medicine, Ludwig-Maximilian University, Munich, Germany
| | - Johannes Manhart
- Institute of Legal Medicine, Rostock University Medical Center, Rostock, Germany
| | - Eva Scheurer
- Department of Biomedical Engineering, Institute of Forensic Medicine, University of Basel, Basel, Switzerland.,Institute of Forensic Medicine, Health Department Basel-Stadt, Basel, Switzerland
| | - Matthias Graw
- Institute of Legal Medicine, Ludwig-Maximilian University, Munich, Germany
| | - Diana Boy
- Institute of Legal Medicine, Rostock University Medical Center, Rostock, Germany
| | - Claudia Lenz
- Department of Biomedical Engineering, Institute of Forensic Medicine, University of Basel, Basel, Switzerland.,Institute of Forensic Medicine, Health Department Basel-Stadt, Basel, Switzerland
| | - Bonnie Hartrampf
- Department of Medicine I, University Hospital Munich, Ludwig Maximilian University, Marchioninistr. 15, 81377, Munich, Germany
| | - Antonia Kellnar
- Department of Medicine I, University Hospital Munich, Ludwig Maximilian University, Marchioninistr. 15, 81377, Munich, Germany
| | - Lauren Sams
- Department of Medicine I, University Hospital Munich, Ludwig Maximilian University, Marchioninistr. 15, 81377, Munich, Germany
| | - Heidi Estner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilian University, Marchioninistr. 15, 81377, Munich, Germany
| | - Stephanie Fichtner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilian University, Marchioninistr. 15, 81377, Munich, Germany
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Van Heuverswyn F, De Buyzere M, Coeman M, De Pooter J, Drieghe B, Duytschaever M, Gevaert S, Kayaert P, Vandekerckhove Y, Voet J, El Haddad M, Gheeraert P. Feasibility and performance of a device for automatic self-detection of symptomatic acute coronary artery occlusion in outpatients with coronary artery disease: a multicentre observational study. LANCET DIGITAL HEALTH 2019; 1:e90-e99. [PMID: 33323233 DOI: 10.1016/s2589-7500(19)30026-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Time delay between onset of symptoms and seeking medical attention is a major determinant of mortality and morbidity in patients with acute coronary artery occlusion. Response time might be reduced by reliable self-detection. We aimed to formally assess the proof-of-concept and accuracy of self-detection of acute coronary artery occlusion by patients during daily life situations and during the very early stages of acute coronary artery occlusion. METHODS In this multicentre, observational study, we tested the operational feasibility, specificity, and sensitivity of our RELF method, a three-lead detection system with an automatic algorithm built into a mobile handheld device, for detection of acute coronary artery occlusion. Patients were recruited continuously by physician referrals from three Belgian hospitals until the desired sample size was achieved, had been discharged with planned elective percutaneous coronary intervention, and were able to use a smartphone; they were asked to perform random ambulatory self-recordings for at least 1 week. A similar self-recording was made before percutaneous coronary intervention and at 60 s of balloon occlusion. Patients were clinically followed up until 1 month after discharge. We quantitatively assessed the operational feasibility with an automated dichotomous quality check of self-recordings. Performance was assessed by analysing the receiver operator characteristics of the ST difference vector magnitude. This trial is registered with ClinicalTrials.gov, number NCT02983396. FINDINGS From Nov 18, 2016, to April 25, 2018, we enrolled 64 patients into the study, of whom 59 (92%) were eligible for self-applications. 58 (91%) of 64 (95% CI 81·0-95·6) patients were able to perform ambulatory self-recordings. Of all 5011 self-recordings, 4567 (91%) were automatically classified as successful within 1 min. In 65 balloon occlusions, 63 index tests at 60 s of occlusion in 55 patients were available. The mean specificity of daily life recordings was 0·96 (0·95-0·97). The mean false positive rate during daily life conditions was 4·19% (95% CI 3·29-5·10). The sensitivity for the target conditions was 0·87 (55 of 63; 95% CI 0·77-0·93) for acute coronary artery occlusion, 0·95 (54 of 57; 0·86-0·98) for acute coronary artery occlusion with electrocardiogram (ECG) changes, and 1·00 (35 of 35) for acute coronary artery occlusion with ECG changes and ST-segment elevation myocardial infarction criteria (STEMI). The index test was more sensitive to detect a 60 s balloon occlusion than the STEMI criteria on 12-lead ECG (87% vs 56%; p<0·0001). The proportion of total variation in study estimates due to heterogeneity between patients (I2) was low (12·6%). The area under the receiver operator characteristics curve was 0·973 (95% CI 0·956-0·990) for acute coronary artery occlusion at different cutoff values of the magnitude of the ST difference vector. No patients died during the study. INTERPRETATION Self-recording with our RELF device is feasible for most patients with coronary artery disease. The sensitivity and specificity for automatic detection of the earliest phase of acute coronary artery occlusion support the concept of our RELF device for patient empowerment to reduce delay and increase Survival without overloading emergency services. FUNDING Ghent University, Industrial Research Fund.
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Affiliation(s)
| | - Marc De Buyzere
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Mathieu Coeman
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Benny Drieghe
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Mattias Duytschaever
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium; Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Peter Kayaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Joeri Voet
- Department of Cardiology, AZ Nikolaas Hospital, Sint-Niklaas, Belgium
| | - Milad El Haddad
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Peter Gheeraert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Postmortem interrogation of cardiac implantable electrical devices may clarify time and cause of death. Int J Legal Med 2018; 133:883-888. [PMID: 30238160 DOI: 10.1007/s00414-018-1932-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Postmortem interrogation of cardiac implantable electrical devices (CIED) in autopsy is not routinely performed. Thus, it remains unclear whether an interrogation might clarify time and cause of death. METHODS Seventy of 4401 patients (1.6%) undergoing autopsy in 2014 and 2015 presented with a CIED. The explanted CIED were interrogated with respect to time and possible cause of death. Battery and lead parameters, clinical and technical alerts, and arrhythmia episodes were reviewed and afterwards correlated with the results of autopsy and clinical data. RESULTS Twenty-five implantable cardioverter defibrillators (ICD) and 45 pacemaker (PM) devices were analyzed. Death was classified as cardiac by autopsy in 17 of 70 patients. Accordingly, presumably lethal ventricular arrhythmias were documented in six patients (8.6%; 5 ICD, 1 PM). In two of 30 patients with unknown cause of death after autopsy (6.7%), interrogation revealed ventricular tachycardia as potential reason for decease (1 ICD, 1 PM). Postmortem CIED interrogation additionally allowed to make a statement regarding the day of death in 36 patients (51%; 13 ICD, 23 PM). This was in accordance with clinical data or the results of autopsy in nine patients (25%; 3 ICD, 6 PM) or could even clarify the time of death in six patients (16.7%; 4 ICD, 2 PM). CONCLUSION Interrogation of CIED revealed potentially lethal ventricular arrhythmias in 9 of 70 patients investigated and enabled valid estimation of the day of death in 15 patients. We therefore conclude that routinely performed postmortem CIED interrogation may clarify time and cause of death.
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