Abstract 17969: Cardiovascular Implantable Electronic Device Longevity Estimates at Autopsy - An Unrealized Resource?: a 5 Year Review of the Johns Hopkins Post-mortem CIED Registry

Introduction: Feasibility of post-mortem CIED (pacemaker (PPM) or defibrillator (ICD)) retrieval for reuse has recently been shown but a model for systematic post-mortem CIED acquisition remains elusive. Prior studies of CIED longevity in retrospective autopsy and funeral home & crematory series have indicated a low yield of usable devices (21 - 30%). However, processes for timely interrogation and reprogramming were not in place. We undertook a registry analysis to determine estimated longevities and reuse potential upon routine CIED retrieval at autopsy. Methods: From May 19, 2009 - May 18, 2014 adult & pediatric autopsy subjects at two academic institutions underwent concomitant CIED pulse generator explantation. The CIED was interrogated by an electrophysiologist, device longevity was cataloged and the device submitted to the applicable manufacturer for formal technical analysis. Results: Seventy (4.3%) of 1642 autopsies had CIEDs. All were retrieved and interrogated within a mean 18.4 ± 14.1 days. There were 30 PPMs and 40 ICDs (4 manufacturers). CIEDs had been implanted for a mean of 2.7 ± 2.4 years and 22/70 (31.4%) had been implanted < 1 year prior to death. Overall, 12/70 CIEDs (17.1%) had a longevity < 1 year (including 5 at elective replacement indication (ERI), 1 recalled PPM, and 1 ICD hard reset), 20/70 (28.6%) had a longevity 1 - < 4 years, and 38/70 (54.3%) had longevity ≥ 4 years. This last group demonstrated a mean longevity of 7.1 ± 2.3 years. Manufacturer technical analyses helped to confirm device longevity status and functionality, identify premature battery depletion, and confirm non-reprogrammable hard reset (due to cold exposure). Conclusion: In contrast to prior studies, our registry analysis demonstrated that the majority of CIEDs retain considerable device longevity and functionality when promptly evaluated post-mortem. Such a systematic approach represents a practical model for post-mortem CIED retrieval, evaluation and potential reuse.