Radiotherapy for patients with cardiovascular implantable electronic devices: an 11-year experience
As cardiovascular implantable electronic devices (CIEDs) are increasingly indicated in older patients, and the burden of cancer is rising with the aging population, the management of patients with CIEDs who require radiotherapy (RT) is a timely concern. The objective of the study was to evaluate the management of, and malfunctions in, patients with CIEDs undergoing RT.
A retrospective study of patients with CIEDs receiving RT at Kingston Health Sciences Center from March 2007–April 2018 was conducted. Data on demographics, RT, devices, and management were compared for the primary outcome of device malfunction.
Of the 189 patients with CIEDs receiving a total of 297 courses of RT, 4 patients (2.1%) experienced device malfunctions. Higher beam energy was associated with a malfunction (p < 0.05). Patients with malfunctions received a lower dose of radiation per fraction (267 ± 93 cGy vs. 477 ± 282 cGy; p < 0.05) and were significantly younger (71.4 ± 2.2 years vs. 77.8 ± 9.8 years; p < 0.01) compared to patients without malfunctions.
RT-induced device malfunctions are rare, but given the potential complications, a better understanding of the potential predictors of malfunction and the development of evidence-based guidelines will help optimize patient safety.
KeywordsPacemaker Implantable cardioverter-defibrillator Radiation Radiotherapy Malfunction
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
- 5.Sabater S, Montero A, Lopez Fernandez T, Gonzalez Ferrer JJ, Arenas M. Management of patients with implanted cardiac devices during radiotherapy: results of a Spanish survey in radiation oncology departments. Clin Transl Oncol. 2018.Google Scholar
- 9.Indik JH, Gimbel JR, Abe H, Alkmim-Teixeira R, Birgersdotter-Green U, Clarke GD, et al. 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm. 2017;14(7):e97–e153.CrossRefPubMedGoogle Scholar
- 10.Gossman MS, Wilkinson JD, Mallick A. Treatment approach, delivery, and follow-up evaluation for cardiac rhythm disease management patients receiving radiation therapy: retrospective physician surveys including chart reviews at numerous centers. Med Dosim. 2014;39(4):320–4.CrossRefPubMedGoogle Scholar
- 21.Hurkmans CW, Knegjens JL, Oei BS, Maas AJ, Uiterwaal GJ, van der Borden AJ, et al. Management of radiation oncology patients with a pacemaker or ICD: a new comprehensive practical guideline in the Netherlands. Dutch Society of Radiotherapy and Oncology (NVRO). Radiat Oncol. 2012;7:198.CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Crossley GH, Poole JE, Rozner MA, Asirvatham SJ, Cheng A, Chung MK, et al. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) expert consensus statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management this document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Heart Rhythm. 2011;8(7):1114–54.CrossRefPubMedGoogle Scholar