Autopsy and clinical context in deceased patients with implanted pacemakers and defibrillators: intracardiac findings near their leads and electrodes

To evaluate intracardiac findings near leads and causes of death in pacemaker/defibrillator patients.

Special autopsy was performed on 78 patients deceased in a hospital. Age at death was 77.9 ± 10.0, implantation-death interval 4.0 ± 3.3 years, ventricular leads n = 78, and atrial leads n = 21 . Thrombi along leads in brachiocephalic vein/upper caval vein (BV/UCV) were found in 22 ( 7 ), in right atrium (RA) in 11 ( 8 ), and in right ventricle (RV) in 11 cases. Bipolar lead rings were fixed by fibrous tissue in 43 (4) cases. Connective tissue bridges and tunnels were found in BV/UCV in 44 (13), in RA in 17 (15), and in RV in 68 cases, with a length of 0.2–12.0 cm. Right ventricular leads in tricuspidal orifice were fixed by fibrous tissue in 11 and penetrating chordae in 25 cases. Main causes of death were: heart failure in 35, pulmonary embolism in 9, and myocardial infarction in 11 cases.

We have found (i) thrombi on ventricular/atrial leads in 33/48%, (ii) bipolar lead rings fixed by fibrous tissue in 68/22%, (iii) connective tissue bridges or tunnels in ventricle/atrium in 87/71%, and (iv) ventricular leads fixed to valve or penetrating chordae in 46% of patients. We do recommend caution when extracting leads.