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Pacemaker/Defibrillator Evaluation at Los Angeles County Department Coroner

NCJ Number
224729
Journal
Journal of Forensic Sciences Volume: 53 Issue: 5 Dated: September 2008 Pages: 1160-1165
Author(s)
Pauline Saint-Martin M.D.; Christopher Rogers M.D.; Joseph Muto B.S.; Noel G. Boyle M.D., Ph.D.; Daniel Rieders M.D.; Lakshmanan Sathyavagiswaran M.D.
Date Published
September 2008
Length
6 pages
Annotation
This article presents four forensic cases from the Los Angeles County Department of the Coroner in order to show how a detailed evaluation of the pacemaker or implantable cardioverter-defibrillator (ICD) in a decedent may provide essential information for the forensic pathologist.
Abstract
One case study shows that information provided by an individual’s pacemaker/ICD can establish both the time and cause of death. In the second case, the decedent had a fall, which was associated with cardiac disease-related syncope. The information from the ICD determined that the defibrillator functioned properly by detecting ventricular fibrillation and delivering a successful rescue shock; however, during the 12 seconds needed for the device to deliver effective therapy the decedent had syncope and a fall that resulted in an ultimately fatal subdural hemorrhage despite the successful defibrillation. In the third case, the 21-year-old victim had a pacemaker implanted at the age of 10 for complete heart block. When she died, the original battery was still present. Although the analysis of the pacemaker’s performance occurred 5 months after the decedent’s death, the battery drainage was minimal, because there was no output to the heart. Given the circumstances of her death, it is highly probable that pacemaker battery depletion played a significant role. In the fourth case, the decedent’s pacemaker was used to identify him, after he was found on the street. Absent a record of his fingerprints and the presence of dentures and no teeth, identification was problematic. During the autopsy, a pacemaker was found. The device was a Medtronic pacemaker, so the investigator found a local number for the company, whose computer records on the pacemaker were used to identify the decedent. 1 table, 3 figures, and 9 references