背景:心脏可植入电子设备(CIED)是一组异构的医疗设备,具有越来越复杂的诊断能力,这可以在法医调查中利用。然而,目前的指导方针缺乏关于这一主题的明确建议。本系统评价的第一个目的是提供对震后ED审讯的作用的最新评估,并提出切实可行的建议,可用于日常实践。其次,作者的目的是确定验尸后的审讯和尸检调查的比率,检测到接近死亡的最终心律类型(重点是记录的心律失常的意义),以及验尸后审讯在确定最终死亡原因/时间中的作用,和任何可能致命的设备故障。
方法:在MEDLINE和Scopus中进行了系统搜索,旨在确定有关死后人类ED询问的报告,包括对参考列表的系统筛选。病例报告,给编辑的信,评论,审查文章或指南被排除在外,以及与ED以外的心脏设备相关的研究。所有数据都使用固定效应荟萃分析模型进行汇总和分析,I2统计量用于评估异质性。
结果:系统评价共纳入25篇,注册3194名死者CIED承运人。10项研究(40%)尸检率100%,而在进一步的6项研究中,尸检结果的报道各不相同;CIED询问来自22项研究(88%),尸检前从未进行过.验尸后ED审讯的总成功率为89%,研究之间具有高度异质性,主要是由于设备停用/电池放电。24%的CIED携带者经历了心脏猝死(SCD),而非心源性猝死和非心源性死亡(NSCD,非传染性疾病)在37%和30%的死者中报告,分别。34%的成功询问的CIED记录了室性快速性心律失常,在经历过SCD的死者中,62%的人;在所有记录的室性心律失常中,在NSCD或NCD中发现40%。明确解释记录的心律失常在死亡原因中的病因作用需要与尸检结果相结合。总的来说,在12%的病例中发现了潜在的致命装置故障.
结论:验尸后询问是确定死因的宝贵工具,并可能补充尸检。法医病理学家需要知道潜在的效用,陷阱,以及这种诊断检查的局限性,以使该工具尽可能可靠。
BACKGROUND: Cardiac implantable electronic devices (CIED) are a heterogeneous group of medical devices with increasingly sophisticated diagnostic capabilities, which could be exploited in forensic investigations. However, current guidelines are lacking clear recommendations on the topic. The first aim of this systematic
review is to provide an updated assessment of the role of postmortem CIED interrogation, and to give practical recommendations, which can be used in daily practice. Secondly, the authors aim to determine the rates of postmortem CIED interrogation and autopsy investigations, the type of final rhythm detected close to death (with a focus on the significance of documented arrhythmias), as well as the role of postmortem CIED interrogation in the determination of final cause/time of death, and any potentially fatal device malfunctions.
METHODS: A systematic search in MEDLINE and Scopus aiming to identify reports concerning postmortem human CIED interrogation was performed, including a systematic screening of reference lists. Case reports, letters to the editors, commentaries,
review articles or guidelines were excluded, along with studies related to cardiac devices other than CIED. All data were pooled and analyzed using fixed-effects meta-analysis models, and the I2 statistic was used to assess heterogeneity.
RESULTS: A total of 25 articles were included in the systematic
review, enrolling 3194 decedent CIED carriers. Ten studies (40%) had a 100% autopsy rate, whereas in further 6 studies autopsy findings were variably reported; CIED interrogation was available from 22 studies (88%), and it was never performed prior to autopsy. The overall rate of successful postmortem CIED interrogation was 89%, with high heterogeneity among studies, mainly due to device deactivation/battery discharge. Twenty-four percent of CIED carriers experienced sudden cardiac death (SCD), whereas non-sudden cardiac and non-cardiac death (NSCD, NCD) were reported in 37% and 30% of decedents, respectively. Ventricular tachyarrhythmias were recorded in 34% of overall successfully interrogated CIED, and in 62% of decedents who experienced a SCD; of all ventricular tachyarrhythmias recorded, 40% was found in NSCD or NCD. A clear interpretation of the etiological role of recorded arrhythmias in the causation of death required integration with autopsy findings. Overall, potentially fatal device malfunctions were detected in 12% of cases.
CONCLUSIONS: Postmortem CIED interrogation is a valuable tool for the determination of the cause of death, and may complement autopsy. Forensic pathologists need to know the potential utility, pitfalls, and limitations of this diagnostic examination to make this tool as much reliable as possible.