The lethal assault, fall trauma or cardiac arrhythmia? – diagnostic difficulties associated with determining the cause of death in a patient with an ICD

The number of patients with implantable cardioverter-defibrillators (ICDs) is steadily increasing. Postmortem interpretation of the data recorded and stored by the device provides vital information about the time and cause of death. In this paper, we describe a case of a 67-year-old man found on the stairs. He had pulseless electrical activity and multiple fresh injuries, notably to the head. Despite an hour-long resuscitation attempt, it was unsuccessful. The subsequent postmortem examination revealed significant myocardial hypertrophy with post-infarction scarring in the left ventricle, and no significant central nervous system injuries were observed. The patient’s ICD was dissected and submitted for analysis. Evaluation of the recorded data revealed the presence of ventricular fibrillation (VF) and tachycardia shortly before the patient was found. Analysis of all the evidence gathered during the investigation led to the conclusion that the cause of death was cardiopulmonary failure resulting from cardiac arrhythmia, and the head injury was a result of an unconscious fall down the stairs.