Presenting Rhythm in Sudden Deaths Temporally Proximate to Discharge of TASER Conducted Electrical Weapons

Authors

  • Charles D. Swerdlow MD,

    1. From the Division of Cardiology, Cedars Sinai Medical Center (CDS, LC), Los Angeles, CA; the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA (MCF), Los Angeles, CA; the Bloch Heart Rhythm Center, University of Kansas Medical Center (DRL), Kansas City, KS; and the Cleveland Clinic (PT), Cleveland, OH.
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  • Michael C. Fishbein MD,

    1. From the Division of Cardiology, Cedars Sinai Medical Center (CDS, LC), Los Angeles, CA; the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA (MCF), Los Angeles, CA; the Bloch Heart Rhythm Center, University of Kansas Medical Center (DRL), Kansas City, KS; and the Cleveland Clinic (PT), Cleveland, OH.
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  • Linda Chaman MPH,

    1. From the Division of Cardiology, Cedars Sinai Medical Center (CDS, LC), Los Angeles, CA; the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA (MCF), Los Angeles, CA; the Bloch Heart Rhythm Center, University of Kansas Medical Center (DRL), Kansas City, KS; and the Cleveland Clinic (PT), Cleveland, OH.
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  • Dhanunjaya R. Lakkireddy MD,

    1. From the Division of Cardiology, Cedars Sinai Medical Center (CDS, LC), Los Angeles, CA; the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA (MCF), Los Angeles, CA; the Bloch Heart Rhythm Center, University of Kansas Medical Center (DRL), Kansas City, KS; and the Cleveland Clinic (PT), Cleveland, OH.
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  • Patrick Tchou MD

    1. From the Division of Cardiology, Cedars Sinai Medical Center (CDS, LC), Los Angeles, CA; the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA (MCF), Los Angeles, CA; the Bloch Heart Rhythm Center, University of Kansas Medical Center (DRL), Kansas City, KS; and the Cleveland Clinic (PT), Cleveland, OH.
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  • Presented at the Heart Rhythm Society Meeting, San Francisco, CA, May 14–17, 2008; and the Heart Rhythm Society meeting, Boston, MA, May 13–16, 2009.

  • Dr. Swerdlow is a member of the TASER International Medical Scientific Advisory Board, which provides advice regarding safety of conducted electrical weapons. Previously, Drs. Tchou and Lakkireddy performed research funded by TASER International (References 9 and 10), but they are not performing such research now. Dr. Fishbein has no potential conflicts. No author has any financial interest in TASER International or any entity related to this manuscript.

  • A related commentary appears on page 771.

Address for correspondance and reprints: Charles Swerdlow, MD; e-mail: swerdlow@ucla.edu.

Abstract

Objectives:  Sudden deaths proximate to use of conducted electrical weapons (CEWs) have been attributed to cardiac electrical stimulation. The rhythm in death caused by rapid, cardiac electrical stimulation usually is ventricular fibrillation (VF); electrical stimulation has not been reported to cause asystole or pulseless electrical activity (PEA). The authors studied the presenting rhythms in sudden deaths temporally proximate to use of TASER CEWs to estimate the likelihood that these deaths could be caused by cardiac electrical stimulation.

Methods:  This was a retrospective review of CEW-associated, nontraumatic sudden deaths from 2001 to 2008. Emergency medical services (EMS), autopsy, and law enforcement reports were requested and analyzed. Subjects were included if they collapsed within 15 minutes of CEW discharge and the first cardiac arrest rhythm was reported.

Results:  Records for 200 cases were received. The presenting rhythm was reported for 56 of 118 subjects who collapsed within 15 minutes (47%). The rhythm was VF in four subjects (7%; 95% confidence interval [CI] = 3% to 17%) and bradycardia-asystole or PEA in 52 subjects (93%; 95% CI = 83% to 97%). None of the eight subjects who collapsed during electrocardiogram (ECG) monitoring had VF. Only one subject (2%) collapsed immediately after CEW discharge. This was the only death typical of electrically induced VF (2%, 95% CI = 0% to 9%). An additional 4 subjects (7%) collapsed within 1 minute, and the remaining 51 subjects (91%) collapsed more than 1 minute later. The time from collapse to first recorded rhythm was 3 minutes or less in 35 subjects (62%) and 5 minutes or less in 43 subjects (77%).

Conclusions:  In sudden deaths proximate to CEW discharge, immediate collapse is unusual, and VF is an uncommon VF presenting rhythm. Within study limitations, including selection bias and the possibility that VF terminated before the presenting rhythm was recorded, these data do not support electrically induced VF as a common mechanism of these sudden deaths.

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