Perspective:

It is clear that as physicians and industry, we have failed to harness the full scope of the information available on CIEDs post-mortem. While CIEDs returned to the manufacturers undergo destructive testing with the goal of quality assurance, as far as one can tell, there is no attempt to collect and analyze clinical information with the goal of patient care quality improvement. In the study, the authors report that among seven subjects with defibrillators and documented ventricular tachycardia/ventricular fibrillation, there were four cases of ventricular undersensing, two cases with unsuccessful final internal shocks, and one case of withheld therapy due to a programmed heart rate cut-off for therapy set above the rate of the ventricular arrhythmia. These findings are consistent with a prior report from University of California at San Francisco, which is quoted in the article, and cautions us against being complacent in regard to the device reliability and optimization of programming. Much can be learned from the device life after a patient’s death.