A migrating pacemaker

Abstract

A deceased 79 year old man with a permanent cardiac pacemaker was due to be cremated, but the pacemaker generator was not detectable by palpation. A hand held metal detector to locate the device so that it could be extracted before cremation.A bout half of all crematoriums in the UK have experienced pacemaker explosions. These may cause structural damage and injury. 1 In an attempt to prevent pacemaker explosions in UK crematoriums, statutory questions on the cremation form ask the attending physician if the deceased had an artificial cardiac pacemaker and if so, whether it has been removed. 2Despite these questions, some pacemakers are not removed before cremation. There are several possible explanations for this. Firstly, the doctor signing the form may mistakenly report that there is no pacemaker in the body. Secondly, cremation forms may not be completed adequately (in one survey, nearly 50% of forms presented to a crematorium were completed insufficiently for the staff to proceed without further inquiry, 3 in another study, 6% of cremation forms had incorrect or incomplete details of pacemaker or radioactive implants, with over 25% of forms being unsatisfactorily completed 4 ). Thirdly, the coroner's form E does not contain the questions about pacemakers. With the coroner's certificate now accounting for up to a third of disposals, 5 it may be that omission of the statutory questions result in some pacemakers remaining in situ. Fourthly, it is possible that only one pacemaker is removed from a body that contains two or more devices, although this is unusual. CASE REPORTAnother reason for non-removal of a pacemaker became apparent when a body of a man in our hospital mortuary was being prepared for cremation. The 79 year old man had died of a type II respiratory failure. The medical notes stated that the body contained a VVI cardiac pacemaker, inserted in 2003 for symptomatic bradycardia. Despite a thorough external examination of the body, we failed to identify the characteristic mass of the pacemaker box. The medical notes were re-examined and a recent electrocardiogram showed an intermittent left bundle branch block pattern following ventricular pacing spikes.We used a commercially available MD-3003 hand held metal detector (J W Electronics, Dolgellau)-similar to those used at airports 6 to scan the thorax of the body-which was placed on a non-metallic surface (fig 1). We ensured that the detector was kept close to the skin to minimise the chance of a false negative result. It produced a signal over the left sixth intercostal space in the mid-axillary line. On superficial dissection, we found the pacemaker box in this site. The migrated box was removed uneventfully, the cremation form completed, and the body released for cremation. DISCUSSIONPacemakers may migrate in the subcutaneous tissue, making detection by palpation difficult. This may explain why some pacemakers remain in bodies that are cremated. Pacemakers may also be placed in the epigastric region at the time of cardiac surgery and will not be i...

Leadless pacemaker and cremation

“…Despite this, a study found that about 50% of the crematoria in the UK have had pacemaker explosions. These explosions lead to losses due to damage of the crematorium and injury to crematoria staff; it is therefore the legal responsibility of physicians, funeral directors and health authorities to prevent such accidents 10 11…”