Death Clutch

Chanting an unholy litany, you reach out with a grasping motion toward your target and cause its heart to leap out of its chest and into your hand. A target with 200 or fewer hit points remaining that fails its saving throw is instantly killed. A target with 201 or more hit points that fails its saving throw manages to keep its heart from leaping out of its chest, but it is still staggered for 1 minute and takes 1d4 points of Constitution drain and 1d4 points of Constitution bleed. Regardless of its current hit points, if the target succeeds at its Fortitude save, it is still staggered for 1 round as it feels its heart wrenching within its chest.