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Lisowski D, Lutyj P, Abazari A, Weick S, Traub J, Polat B, Flentje M, Kraft J. Impact of Radiotherapy on Malfunctions and Battery Life of Cardiac Implantable Electronic Devices in Cancer Patients. Cancers (Basel) 2023; 15:4830. [PMID: 37835524 PMCID: PMC10571836 DOI: 10.3390/cancers15194830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE This study analyses a large number of cancer patients with CIEDs for device malfunction and premature battery depletion by device interrogation after each radiotherapy fraction and compares different guidelines in regard to patient safety. METHODS From 2007 to 2022, a cohort of 255 patients was analyzed for CIED malfunctions via immediate device interrogation after every RT fraction. RESULTS Out of 324 series of radiotherapy treatments, with a total number of 5742 CIED interrogations, nine device malfunctions (2.8%) occurred. Switching into back-up/safety mode and software errors occurred four times each. Once, automatic read-out could not be performed. The median prescribed cumulative dose at planning target volume (PTV) associated with CIED malfunction was 45.0 Gy (IQR 36.0-64.0 Gy), with a median dose per fraction of 2.31 Gy (IQR 2.0-3.0 Gy). The median maximum dose at the CIED at time of malfunction was 0.3 Gy (IQR 0.0-1.3 Gy). No correlation between CIED malfunction and maximum photon energy (p = 0.07), maximum dose at the CIED (p = 0.59) nor treatment localization (p = 0.41) could be detected. After excluding the nine malfunctions, premature battery depletion was only observed three times (1.2%). Depending on the national guidelines, 1-9 CIED malfunctions in this study would have been detected on the day of occurrence and in none of the cases would patient safety have been compromised. CONCLUSION Radiation-induced malfunctions of CIEDs and premature battery depletion are rare. If recommendations of national safety guidelines are followed, only a portion of the malfunctions would be detected directly after occurrence. Nevertheless, patient safety would not be compromised.
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Affiliation(s)
- Dominik Lisowski
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Paul Lutyj
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Arya Abazari
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Stefan Weick
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Jan Traub
- Department of Internal Medicine I, Division of Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
| | - Johannes Kraft
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany (J.K.)
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Mirzaei M, Rowshanfarzad P, Gill S, Ebert MA, Dass J. Risk of cardiac implantable device malfunction in cancer patients receiving proton therapy: an overview. Front Oncol 2023; 13:1181450. [PMID: 37469405 PMCID: PMC10352826 DOI: 10.3389/fonc.2023.1181450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Age is a risk factor for both cardiovascular disease and cancer, and as such radiation oncologists frequently see a number of patients with cardiac implantable electronic devices (CIEDs) receiving proton therapy (PT). CIED malfunctions induced by PT are nonnegligible and can occur in both passive scattering and pencil beam scanning modes. In the absence of an evidence-based protocol, the authors emphasise that this patient cohort should be managed differently to electron- and photon- external beam radiation therapy (EBRT) patients due to distinct properties of proton beams. Given the lack of a PT-specific guideline for managing this cohort and limited studies on this important topic; the process was initiated by evaluating all PT-related CIED malfunctions to provide a baseline for future reporting and research. In this review, different modes of PT and their interactions with a variety of CIEDs and pacing leads are discussed. Effects of PT on CIEDs were classified into a variety of hardware and software malfunctions. Apart from secondary neutrons, cumulative radiation dose, dose rate, CIED model/manufacturer, distance from CIED to proton field, and materials used in CIEDs/pacing leads were all evaluated to determine the probability of malfunctions. The importance of proton beam arrangements is highlighted in this study. Manufacturers should specify recommended dose limits for patients undergoing PT. The establishment of an international multidisciplinary team dedicated to CIED-bearing patients receiving PT may be beneficial.
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Affiliation(s)
- Milad Mirzaei
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Department of Medical Imaging and Radiation Sciences, School of Biomedical Sciences, Monash University, Clayton, VIC, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA, Australia
| | - Suki Gill
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA, Australia
| | - Martin A. Ebert
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA, Australia
| | - Joshua Dass
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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3
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Xu B, Wang Y, Tse G, Chen J, Li G, Korantzopoulos P, Liu T. Radiotherapy-induced malfunctions of cardiac implantable electronic devices: A meta-analysis. Heart Rhythm 2023; 20:689-698. [PMID: 36708909 DOI: 10.1016/j.hrthm.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/18/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Radiation therapy (RT) may pose acute and long-term risks for patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). OBJECTIVE We conducted a systematic review and meta-analysis to examine the association between RT and PM/ICD malfunctions in patients with cancer. METHODS We searched the literature using the PubMed, the Cochrane Library the Web of Science, and Embase for relative publications until April 2022. Of the 550 initially identified studies, 17 retrospective observational studies including 2454 patients were finally analyzed. RESULTS The meta-analysis showed that RT was associated with an increased risk of ICD malfunctions (odds ratio [OR] 2.75; 95% confidence interval [CI] 1.74-4.33). Five studies were included in the subgroup analysis regarding photon beam energy, showing that radiation-induced CIED failure was more likely to occur in ICDs when beam energy was ≥10 MV (OR 5.28; 95% CI 2.14-13.03). Neutron-generating RT significantly increased the risk of CIED malfunctions (OR 3.97; 95% CI 1.70-9.26), especially the risk of reset (OR 5.79; 95% CI 2.37-14.12; P = .0001). We did not find significant differences in the risk of CIED failure between chest RT and other RT sites (OR 1.09; 95% CI 0.63-1.88). CONCLUSION Our meta-analysis suggests that ICDs are more likely to be affected by RT than PMs. These adverse events, especially reset, in patients with cancer were associated with neutron-generating RT and beam energy ≥10 MV. Given the increasing requirement for RT in several patients with cancer as well as the increasing implantation rates of CIEDs, a better risk stratification is needed in this setting.
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Affiliation(s)
- Beizheng Xu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yueying Wang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, Hong Kong; Kent and Medway Medical School, Canterbury, Kent, United Kingdom; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | | | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
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Malavasi VL, Imberti JF, Tosetti A, Romiti GF, Vitolo M, Zecchin M, Mazzeo E, Giuseppina DM, Lohr F, Lopez-Fernandez T, Boriani G. A systematic review and meta-analysis on oncological radiotherapy in patients with a cardiac implantable electronic device: Prevalence and predictors of device malfunction in 3121 patients. Eur J Clin Invest 2023; 53:e13862. [PMID: 36004486 PMCID: PMC10078179 DOI: 10.1111/eci.13862] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The number of patients with cardiac implantable electronic devices (CIEDs) undergoing radiotherapy (RT) for cancer treatment is growing. At present, prevalence and predictors of RT-induced CIEDs malfunctions are not defined. METHODS Systematic review and meta-analysis conducted following the PRISMA recommendations. PubMed, Scopus and Google Scholar were searched from inception to 31/01/2022 for studies reporting RT-induced malfunctions in CIEDs patients. Aim was to assess the prevalence of RT-induced CIEDs malfunctions and identify potential predictors. RESULTS Thirty-two out of 3962 records matched the inclusion criteria and were included in the meta-analysis. A total of 135 CIEDs malfunctions were detected among 3121 patients (6.6%, 95% confidence interval [CI]: 5.1%-8.4%). The pooled prevalence increased moving from pacemaker (PM) to implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy and defibrillator (CRT-D) groups (4.1%, 95% CI: 2.9-5.8; 8.2% 95% CI: 5.9-11.3; and 19.8%, 95% CI: 11.4-32.2 respectively). A higher risk ratio (RR) of malfunctions was found when neutron-producing energies were used as compared to non-neutron-producing energies (RR 9.98, 95% CI: 5.09-19.60) and in patients with ICD/CRT-D as compared to patients with PM/CRT-P (RR 2.07, 95% CI: 1.40-3.06). On the contrary, no association was found between maximal radiation dose at CIED >2 Gy and CIEDs malfunctions (RR 0.93; 95% CI: 0.31-2.76). CONCLUSIONS Radiotherapy related CIEDs malfunction had a prevalence ranging from 4% to 20%. The use of neutron-producing energies and more complex devices (ICD/CRT-D) were associated with higher risk of device malfunction, while the radiation dose at CIED did not significantly impact on the risk unless higher doses (>10 Gy) were used.
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Affiliation(s)
- Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Alberto Tosetti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza-University of Rome, Rome, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Massimo Zecchin
- Cardiovascular Department, Ospedali Riuniti, University of Trieste, Trieste, Italy
| | - Ercole Mazzeo
- Radiotherapy Division, Department of Oncology, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - De Marco Giuseppina
- Radiotherapy Division, Department of Oncology, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Frank Lohr
- Radiotherapy Division, Department of Oncology, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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5
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Stühlinger M, Burri H, Vernooy K, Garcia R, Lenarczyk R, Sultan A, Brunner M, Sabbag A, Özcan EE, Ramos JT, Di Stolfo G, Suleiman M, Tinhofer F, Aristizabal JM, Cakulev I, Eidelman G, Yeo WT, Lau DH, Mulpuru SK, Nielsen JC, Heinzel F, Prabhu M, Rinaldi CA, Sacher F, Guillen R, de Pooter J, Gandjbakhch E, Sheldon S, Prenner G, Mason PK, Fichtner S, Nitta T. EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices. Europace 2022; 24:1512-1537. [PMID: 36228183 DOI: 10.1093/europace/euac040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Markus Stühlinger
- Department of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rodrigue Garcia
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center of Heart Diseases, Zabrze, Poland
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Arian Sultan
- Department of Electrophysiology, Heart Center at University Hospital Cologne, Cologne, Germany
| | - Michael Brunner
- Department of Cardiology and Medical Intensive Care, St Josefskrankenhaus, Freiburg, Germany
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Emin Evren Özcan
- Heart Rhythm Management Center, Dokuz Eylul University, İzmir, Turkey
| | - Jorge Toquero Ramos
- Cardiac Arrhythmia and Electrophysiology Unit, Cardiology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Giuseppe Di Stolfo
- Cardiac Intensive Care and Arrhythmology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mahmoud Suleiman
- Cardiology/Electrophysiology, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Ivan Cakulev
- University Hospitals of Cleveland, Case Western University, Cleveland, OH, USA
| | - Gabriel Eidelman
- San Isidro's Central Hospital, Diagnóstico Maipú, Buenos Aires Province, Argentina
| | - Wee Tiong Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Frank Heinzel
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, 13353 Berlin, Germany
| | - Mukundaprabhu Prabhu
- Associate Professor in Cardiology, In charge of EP Division, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | | | - Frederic Sacher
- Bordeaux University Hospital, Univ. Bordeaux, Bordeaux, France
| | - Raul Guillen
- Sanatorio Adventista del Plata, Del Plata Adventist University Entre Rios Argentina, Entre Rios, Argentina
| | - Jan de Pooter
- Professor of Cardiology, Ghent University, Deputy Head of Clinic, Heart Center UZ Gent, Ghent, Belgium
| | - Estelle Gandjbakhch
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Institut de Cardiologie, ICAN, Paris, France
| | - Seth Sheldon
- The Department of Cardiovascular Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | | | - Pamela K Mason
- Director, Electrophysiology Laboratory, University of Virginia, Charlottesville, VA, USA
| | - Stephanie Fichtner
- LMU Klinikum, Medizinische Klinik und Poliklinik I, Campus Großhadern, München, Germany
| | - Takashi Nitta
- Emeritus Professor, Nippon Medical School, Presiding Consultant of Cardiology, Hanyu General Hospital, Saitama, Japan
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6
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Frey P, Irles D, Dompnier A, Akret C, Hosu IC, Narayanan K, Mazoyer F, Yayehd K, Guillon B, Marijon E. Cardiac Implantable Electronic Device Dysfunctions in Patients Undergoing Radiotherapy A Prospective Cohort Study. J Cardiovasc Electrophysiol 2022; 33:1013-1023. [PMID: 35299286 DOI: 10.1111/jce.15449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasing numbers of patients with cardiac implantable electronic devices (CIEDs) are undergoing radiotherapy for cancer. The aim of the study was to prospectively evaluate the incidence, characteristics, and associated factors of CIED dysfunctions related to radiotherapy. METHODS Between April 2013 and March 2020, all patients with a CIED who underwent ≥1 radiotherapy session were enrolled. Patients were monitored according to a systematic protocol, including device interrogation before the 1st and after each radiotherapy session. The primary endpoint was CIED dysfunction, defined as oversensing, total or partial deprogramming, and/or unrecoverable reset. RESULTS We included a total of 92 CIED radiotherapy courses: 77 (83.7%) in patients with a pacemaker and 15 (16.3%) in those with an implantable cardioverter defibrillator. Overall, 13 dysfunctions (14.1%) were observed during 92 courses (1509 sessions), giving an incidence of 0.9 per 100 sessions. These included nine deprogramming (three total resets to back-up pacing mode and six partial deprogramming that were all successfully reprogrammed), three transient oversensing, and one unrecoverable oversensing requiring CIED and leads replacement. There were no adverse clinical events related to device dysfunction. In multivariable analysis, neutron-producing irradiation (odds ratio [OR], 5.59; 95% confidence interval [CI], 1.09-28.65; P=0.039) and cumulative tumor dose (OR, 1.05; 95% CI, 1.01-1.10; P=0.007) remained significantly associated with CIED dysfunction. CONCLUSIONS In this prospective study, transient or permanent subclinical CIED dysfunction occurred in 14.1% of radiotherapy courses. Our findings emphasize the importance of high-energy beams and neutron-producing irradiation in risk assessment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pierre Frey
- Department of cardiology, Centre Hospitalier Annecy Genevois, 1 Avenue de l'Hôpital, 74370, Metz-Tessy, France
| | - Didier Irles
- Department of cardiology, Centre Hospitalier Annecy Genevois, 1 Avenue de l'Hôpital, 74370, Metz-Tessy, France
| | - Antoine Dompnier
- Department of cardiology, Centre Hospitalier Annecy Genevois, 1 Avenue de l'Hôpital, 74370, Metz-Tessy, France
| | - Chrystelle Akret
- Department of cardiology, Centre Hospitalier Annecy Genevois, 1 Avenue de l'Hôpital, 74370, Metz-Tessy, France
| | - Iolanda C Hosu
- Department of radiotherapy, Centre Hospitalier Annecy Genevois, 1 Avenue de l'Hôpital, 74370, Metz-Tessy, France
| | - Kumar Narayanan
- University of Paris, Paris-Cardiovascular Research Center, INSERM, F-75015, Paris, France.,Medicover Hospitals, Hyderabad, India
| | - Fréderic Mazoyer
- Department of radiotherapy, Centre Hospitalier Annecy Genevois, 1 Avenue de l'Hôpital, 74370, Metz-Tessy, France
| | - Komlavi Yayehd
- Department of cardiology, CHU Campus Lomé, 03 BP, 30284, Lomé, Togo
| | - Benoît Guillon
- Department of cardiology, University Hospital Besancon, 25000, Besancon, France.,EA3920, University of Burgundy-Franche-Comté, Besancon, France
| | - Eloi Marijon
- University of Paris, Paris-Cardiovascular Research Center, INSERM, F-75015, Paris, France.,Cardiology department, European Georges Pompidou Hospital, 75908, Paris, Cedex, 15, France
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7
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Daniela Falco M, Andreoli S, Delana A, Barbareschi A, De Filippo P, Leidi C, Marini M, Appignani M, Genovesi D, Di Girolamo E. In-vitro investigation of cardiac implantable electronic device malfunction during and after direct photon exposure: A three-centres experience. Phys Med 2022; 94:94-101. [PMID: 35007940 DOI: 10.1016/j.ejmp.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/26/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Radiotherapy may cause malfunction of implantable cardioverter-defibrillators (ICDs) and pacemakers (PMs). We carried-out a multicentre randomized in-vitro study on 65 ICDs and 145 PMs to evaluate malfunctions during and after direct irradiation to doses up to 10 Gy. METHODS Three centres equipped with different linear accelerator and treatment-planning systems participated in the study. Computed Tomography (CT) acquisitions were performed to build the treatment plans. All devices were exposed to dose of 2, 5, or 10 Gy (6 MV). All devices underwent a baseline examination and 64 wireless real-time telemetry-transmissions (47 ICDs and 17 PMs) were monitored during photon exposures. All devices were interrogated after exposure and once monthly for six subsequent months. RESULTS Fifty-four of the 64 wireless-enabled CIEDs (84.4%) recorded noise-related interferences during exposure. In detail, 40/47 ICDs (85.1%) reported interference, of which 16 ICDs (34%) reported potentially clinically relevant pacing inhibition and inappropriate detections. Following exposure, a soft reset occurred in 1/145 PM (0.7%) while 7/145 PMs (4.8%) reported battery issues. During the six-month follow-up, 1/145 PM (0.7%) reported a soft reset, while 12/145 more PMs (8.3%) and 1/64 ICD (1.5%) showed abnormal battery depletion. All reported issues occurred independently of exposure dose. Finally, irreversible effects on software and battery life occurred in only non-MRI-compatible devices. CONCLUSION ICDs mostly featured real-time transient sensing issues, while PMs mostly experienced long-term battery or software issues that were observed immediately following radiation exposure and during follow-up. Irreversible effects on battery life and software occurred in only non-MRI-compatible devices.
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Affiliation(s)
- Maria Daniela Falco
- Department of Radiation Oncology, "G. D'Annunzio" University, "SS. Annunziata" Hospital, Chieti, Italy.
| | - Stefano Andreoli
- Medical Physics Unit, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Anna Delana
- Medical Physics Unit, "S. Chiara" Hospital, Trento, Italy
| | | | - Paolo De Filippo
- Electrophysiology Unit, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Cristina Leidi
- Electrophysiology Unit, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | | | | | - Domenico Genovesi
- Department of Radiation Oncology, "G. D'Annunzio" University, "SS. Annunziata" Hospital, Chieti, Italy
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8
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Okano N, Sakai M, Shibuya K, Tsuda K, Kanzaki T, Sano M, Kaneko Y, Ohno T. Safety verification of carbon-ion radiotherapy for patients with cardiac implantable electronic devices (CIEDs). JOURNAL OF RADIATION RESEARCH 2022; 63:122-127. [PMID: 34747483 PMCID: PMC8776694 DOI: 10.1093/jrr/rrab105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/17/2021] [Indexed: 06/13/2023]
Abstract
According to guidelines, carbon-ion beam therapy is considered to carry a high safety risk for patients with cardiac implantable electronic devices (CIEDs), although the actual impacts remain unclear. In this study, we investigated the safety of carbon-ion beam therapy in patients with CIEDs. Patients with CIEDs who underwent carbon-ion therapy at Gunma University Heavy Ion Medical Center between June 2010 and December 2019 were identified and investigated for abnormalities in the operation of their CIEDs, such as oversensing and resetting during irradiation, and abnormalities in operation after treatment. In addition, the risk of irradiation from carbon-ion beam therapy was evaluated by model simulations. Twenty patients (22 sites) with CIEDs were identified, 19 with pacemakers and one with an implantable cardioverter-defibrillator (ICD). Treatments were completed without any problems, except for one case in which the treatment was discontinued because of worsening of the primary disease. Monte Carlo simulation indicated that the carbon beam irradiation produced neutrons at a constant and high level in the irradiation field. Nevertheless, with the distances between the CIEDs and the irradiation fields in the analyzed cases, the quantity of neutrons at the CIEDs was lower than that within the irradiation. Although carbon-ion beam therapy can be safely administered to patients with CIEDs, it is advisable to perform the therapy with sufficient preparation and backup devices because of the risks involved.
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Affiliation(s)
- Naoko Okano
- Corresponding author. Naoko Okano, Gunma University, Heavy Ion Medical Center, 371-8511, 3-39-22 Showa-machi Maebashi, Gunma, Japan. Tel: (+81) 27-220-8383; Fax: (+81) 27-220-8384;
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9
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Bjerre HL, Kronborg MB, Nielsen JC, Høyer M, Jensen MF, Zaremba T, Lægdsmand PMT, Søndergaard CS, Nyström H, Kronborg CJS. Risk of Cardiac Implantable Electronic Device Malfunctioning During Pencil Beam Proton Scanning in an In Vitro Setting. Int J Radiat Oncol Biol Phys 2021; 111:186-195. [PMID: 33845147 DOI: 10.1016/j.ijrobp.2021.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/08/2021] [Accepted: 03/30/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Cardiac implantable electronic devices (CIED) are sensitive to scattered secondary neutrons from proton beam irradiation. This experimental in vitro study investigated risk of CIED errors during pencil beam proton therapy. METHODS AND MATERIALS We used 62 explanted CIEDs from 4 manufacturers; 49 CIEDs were subjected to a simulated clinical protocol with daily 2 Gy relative biological effectiveness fractions prescribed to the phantom. Devices were located at 3 different lateral distances from the spread-out Bragg peak to investigate the risk of permanent or temporary device errors. Additionally, 13 devices with leads connected were monitored live during consecutive irradiations to investigate the risk of noise, over- or undersense, pace inhibition, and inappropriate shock therapy. RESULTS We detected 61 reset errors in 1728 fractions, and all except 1 CIED were reprogrammed to normal function. All, except 1 reset, occurred in devices from the same manufacturer. These were successfully reprogrammed to normal function. The 1 remaining CIED was locked in permanent safety mode. Secondary neutron dose, as estimated by Monte Carlo simulations, was found to significantly increase the odds of CIED resets by 55% per mSv. Clinically significant battery depletion was observed in 5 devices. We observed no noise, over- or undersense, pace inhibition, or inappropriate shock therapy during 362 fractions of live monitoring. CONCLUSIONS Reprogrammable CIED reset was the most commonly observed malfunction during proton therapy, and reset risk depended on secondary neutron exposure. The benefits of proton therapy are expected to outweigh the risk of CIED malfunctioning for most patients.
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Affiliation(s)
- Henrik Laurits Bjerre
- Department of Cardiology, Aarhus University Hospital, Denmark; Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark.
| | | | | | - Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | | | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Denmark
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10
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Gauter-Fleckenstein B, Barthel C, Büttner S, Wenz F, Borggrefe M, Tülümen E. Effectivity and applicability of the German DEGRO/DGK-guideline for radiotherapy in CIED-bearing patients. Radiother Oncol 2020; 152:208-215. [DOI: 10.1016/j.radonc.2020.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/07/2019] [Accepted: 01/07/2020] [Indexed: 11/26/2022]
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11
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Schernthaner C, Kopp M, Dagn K, Rettenbacher L, Weiss L, Meyersburg D, Brandt MC, Hoppe UC, Strohmer B. Safe application of extensive radiotherapy to a cardiac resynchronization device. ESC Heart Fail 2020; 7:4293-4296. [PMID: 33040476 PMCID: PMC7754946 DOI: 10.1002/ehf2.12869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/09/2020] [Accepted: 06/10/2020] [Indexed: 11/25/2022] Open
Abstract
Patients with cardiac implantable electronic devices undergoing radiotherapy (RT) are prone to the risk of device failure. Guidelines and manufacturer's instructions are lacking practical recommendations for cumulative radiation doses to pacemakers or implantable cardioverter defibrillators. The present case demonstrates the effect of RT of a Merkel cell carcinoma near the location of a cardiac resynchronization therapy pacemaker. Despite guideline recommendations, surgical relocation or de novo implantation of the device on the contralateral side was avoided to prevent the dissemination of tumour cells, inflammation, and wound healing complications. A total dose of 47.25 Gy applied in very close proximity to the cardiac resynchronization therapy pacemaker was carried out safely without jeopardizing the patient and any device malfunction during and after treatment within >1.5 years of follow‐up period. The present case demonstrates that high‐dose RT near to a cardiac resynchronization therapy device can be carried out safely. Special precautions during RT as well as close device follow‐up interrogations are mandatory. Large‐scale studies are needed for the true frequency of adverse events.
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Affiliation(s)
- Christiana Schernthaner
- Department of Cardiology, Paracelsus Medical University, Muellner Hauptstrasse 48, Salzburg, A-5020, Austria
| | - Michael Kopp
- Department of Radiotherapy and Radio-oncology, Paracelsus Medical University, Salzburg, Austria
| | - Karin Dagn
- Department of Radiotherapy and Radio-oncology, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Rettenbacher
- Department of Nuclear Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Weiss
- Department of Oncology, Salzburg Cancer Research Institute, Paracelsus Medical University, Salzburg, Austria
| | - Damian Meyersburg
- Department of Dermatology, Paracelsus Medical University, Salzburg, Austria
| | - Mathias-Christoph Brandt
- Department of Cardiology, Paracelsus Medical University, Muellner Hauptstrasse 48, Salzburg, A-5020, Austria
| | - Uta C Hoppe
- Department of Cardiology, Paracelsus Medical University, Muellner Hauptstrasse 48, Salzburg, A-5020, Austria
| | - Bernhard Strohmer
- Department of Cardiology, Paracelsus Medical University, Muellner Hauptstrasse 48, Salzburg, A-5020, Austria
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12
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Malavasi VL, De Marco G, Imberti JF, Placentino F, Vitolo M, Mazzeo E, Cicoria G, Casali E, Turco V, Lohr F, Boriani G. Radiotherapy-induced malfunctions of cardiac implantable electronic devices in cancer patients. Intern Emerg Med 2020; 15:967-973. [PMID: 31792775 DOI: 10.1007/s11739-019-02240-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022]
Abstract
The number of patients with cardiac implantable electronic devices (CIEDs) requiring radiation therapy (RT) for cancer treatment is increasing. The purpose of this study is to estimate the prevalence, possible predictors, and clinical impact of RT-related CIEDs malfunctions. We retrospectively reviewed the medical records of all pacemaker (PM)/implantable cardioverter-defibrillator (ICD) patients who underwent RT in the last 14 years. One hundred and twenty-seven patients who underwent 150 separate RT courses were analysed (99 with a PM and 27 with an ICD). Of note, 21/127 (16.6%) patients were PM-dependent. Neutron-producing RT was used in 37/139 (26.6%) courses, whereas non-neutron-producing RT was used in 102/139 (73.4%) courses. The cumulative dose (Dmax) delivered to the CIED exceeded 5 Gy only in 2/132 (1.5%) cases. Device malfunctions were observed in 3/150 (2%) RT courses, but none was life-threatening or led to a major clinical event and all were resolved by CIED reprogramming. In all cases, the Dmax delivered to the CIED was < 2 Gy. Two malfunctions occurred in the 37 patients treated with neutron-producing RT (5.4%), and 1 malfunction occurred in the 102 patients treated with non-neutron-producing RT (1%) (p = 0.17). Device relocation from the RT field was performed in 2/127 (1.6%) patients. RT in patients with CIED is substantially safe if performed in an appropriately organized environment, with uncommon CIEDs malfunctions and no major clinical events. Neutron-producing energies, rather than Dmax, seem to increase the risk of malfunctions. Device interrogation on a regular basis is advised to promptly manage CIED malfunctions.
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Affiliation(s)
- Vincenzo L Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Giuseppina De Marco
- Radiotherapy Division, Department of Oncology, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Filippo Placentino
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Ercole Mazzeo
- Radiotherapy Division, Department of Oncology, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | | | - Edoardo Casali
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Vincenzo Turco
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Frank Lohr
- Radiotherapy Division, Department of Oncology, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy.
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Falco MD, Genovesi D, Caravatta L, Di Carlo C, Bliakharskaia E, Appignani M, Faustino M, Furia N, Di Girolamo E. A randomized in vitro evaluation of transient and permanent cardiac implantable electronic device malfunctions following direct exposure up to 10 Gy. Strahlenther Onkol 2020; 197:198-208. [PMID: 32561941 DOI: 10.1007/s00066-020-01651-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE High-dose 6‑MV radiotherapy may cause cardiac implantable electronic devices (CIEDs) to malfunction. To assess CIED malfunctions resulting from direct exposure up to 10 Gy, 100 pacemakers (PMs) and 40 implantable cardioverter-defibrillators (ICDs) were evaluated. MATERIALS AND METHODS CIEDs underwent baseline interrogation. In ICDs, antitachycardia therapies were disabled via the programmer while the detection windows were left enabled. A computed tomography (CT) scan was performed to build the corresponding treatment plan. CIEDs were "blinded" and randomized to receive single doses of either 2, 5, or, 10 Gy via a 6-MV linear accelerator (linac) in a water phantom. Twenty-two wireless telemetry-enabled CIEDs underwent a real-time session, and their function was recorded by the video camera in the bunker. The CIEDs were interrogated after exposure and once monthly for 6 months. RESULTS During exposure, regardless of dose, 90.9% of the CIEDs recorded electromagnetic interference, with 6 ICDs (27.3%) reporting pacing inhibition and inappropriate arrhythmia detections. After exposure, a backup reset was observed in 1 PM (0.7% overall, 1% among PMs), while 7 PMs (5% overall, 7% among PMs) reported battery issues (overall immediate malfunction rate was 5.7%). During follow-up, 4 PMs (2.9% overall; 4% among PMs) and 1 ICD (0.7% overall; 2.5% among ICDs) reported abnormal battery depletion, and 1 PM (0.7% overall; 1% among PMs) reported a backup reset (overall late malfunction rate was 4.3%). CONCLUSION Apart from transient electromagnetic interference, last-generation CIEDs withstood direct 6‑MV exposure up to 10 Gy. Permanent battery or software errors occurred immediately or later only in less recent CIEDs.
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Affiliation(s)
- Maria Daniela Falco
- Department of Radiation Oncology, "SS. Annunziata" Hospital, "G. D'Annunzio" University, Via De' Vestini, 66100, Chieti, Italy.
| | - Domenico Genovesi
- Department of Radiation Oncology, "SS. Annunziata" Hospital, "G. D'Annunzio" University, Via De' Vestini, 66100, Chieti, Italy
| | - Luciana Caravatta
- Department of Radiation Oncology, "SS. Annunziata" Hospital, "G. D'Annunzio" University, Via De' Vestini, 66100, Chieti, Italy
| | - Clelia Di Carlo
- Department of Radiation Oncology, "SS. Annunziata" Hospital, "G. D'Annunzio" University, Via De' Vestini, 66100, Chieti, Italy
| | - Ekaterina Bliakharskaia
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | - Nanda Furia
- Arrhythmology Unit, "SS. Annunziata" Hospital, Chieti, Italy
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Radiotherapy is safe in patients with implantable cardiac devices. Analysis of a systematic interrogation follow-up. Clin Transl Oncol 2020; 22:2286-2292. [PMID: 32419111 DOI: 10.1007/s12094-020-02374-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The number of patients who have a cardiac implantable electronic device (CIEDs) that undergo a course of radiotherapy is increasing due to the ageing population. The majority of clinical studies only evaluate any CIED malfunction at the end of a course of irradiation or in a case of there being symptoms of possible malfunction. As a result, little data has been collected on CIED status acquired during an active course of irradiation. MATERIAL AND METHODS We aimed to evaluate the correct functioning of a CIED during a course of radiotherapy. So, a retrospective analysis was made of all patients having CIEDS in a single institution during their course of radiotherapy. All CIEDs were systematically checked before and during the course of radiotherapy according to the risk of device failure and patient dependence. RESULTS Data was analysed from 56 patients (43 men, 13 women) with a mean age of 78.2 years, of whom 87.5% of the patients carried a pacemaker (PM), the 39% of the patients were PM dependent, and the remaining patients carried an implantable cardioverter-defibrillator (ICD). An observable dose of irradiation was evident in only 10 cases. 69.1% of the CIEDs were checked daily and the remainder were checked weekly. During the radiotherapy course, 82% of the patients did not complain of any cardiological event. The CIED of five patients experienced an increase in the threshold and, in another case, a sudden reduction in the duration of the battery was reported. Another patient with a CIED experienced a cardiac insufficiency episode triggered by a ventricular tachycardia. CONCLUSION In conclusions, although adverse clinical events from exposure of a CIED to irradiation are rare, they can appear in any group of risk. No dose-dependency was observed on the malfunction of the CIED.
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Matsubara H, Ezura T, Hashimoto Y, Karasawa K, Nishio T, Tsuneda M. Prediction of radiation‐induced malfunction for cardiac implantable electronic devices (CIEDs). Med Phys 2020; 47:1489-1498. [DOI: 10.1002/mp.14057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 01/22/2019] [Accepted: 01/25/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hiroaki Matsubara
- Department of Radiation Oncology Tokyo Women’s Medical University Tokyo 162‐8666Japan
| | - Takatomo Ezura
- Department of Radiology Tokyo Women’s Medical University Hospital Tokyo 162‐8666Japan
| | - Yaichiro Hashimoto
- Department of Radiation Oncology Tokyo Women’s Medical University Tokyo 162‐8666Japan
| | - Kumiko Karasawa
- Department of Radiation Oncology Tokyo Women’s Medical University Tokyo 162‐8666Japan
| | - Teiji Nishio
- Department of Radiation Oncology Tokyo Women’s Medical University Tokyo 162‐8666Japan
| | - Masato Tsuneda
- Department of Radiation Oncology Tokyo Women’s Medical University Tokyo 162‐8666Japan
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Gimenez De Lorenzo R, Navarra R, Marinelli D, Adorante N, Giancaterino S, Di Carlo C, Di Biase S, Rosa C, Falco MD. Effects of high-energy photon beam radiation therapy on Jarvik 2000 LVAD: in vitro evaluation. Radiol Med 2020; 125:561-568. [PMID: 32067164 DOI: 10.1007/s11547-020-01154-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Left ventricular assist device (LVAD) is considered a standard care for patients with advanced heart failure. The aim of this work was to study in vitro the effects of direct exposure of the Jarvik 2000 LVAD to 10-MV photon beams. METHODS Jarvik 2000 pump was immersed in a siliconized box filled with deionized water. A 30 × 30 × 15 cm RW3 slabs were added forth and back to the box. A treatment plan consisting of a single direct 10 × 10 cm2 field size beam was used to deliver 1000 MU at the center of the pump. During irradiation, the external Flow Maker controller and the lithium battery were positioned away from the beam. Pump parameter data (included voltage, current and frequency) were measured, recorded and analyzed for changes in pump function among baseline, pre-irradiation, during irradiation, post-irradiation and after 6 months. The whole session lasted 6 months. The Mann-Whitney U test was used to compare the repeated measurements. X-ray radiation attenuation was also studied. RESULTS The parameters investigated remained stable over the 6 months; that is, no pump stops, alarms, events, operational changes or abnormalities during the discharge rate of the connected power sources, were encountered, confirmed by the Mann-Whitney U test applied to all sessions (p > 0.1). The measured X-ray attenuation differed from the calculated one by TPS by 34%. CONCLUSION The Jarvik 2000 resulted stable under direct X-ray beam of 10-MV energy. Its strong attenuation, however, can affect dose deposition in the pump in TPS, and it must be taken into account.
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Affiliation(s)
- Ramon Gimenez De Lorenzo
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Riccardo Navarra
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy.,Department of Neuroimaging and Cognitive Science, University of Chieti "G. D'Annunzio", Chieti, Italy
| | - Daniele Marinelli
- Department of Cardiac Surgery, University of Chieti "G. D'Annunzio", Chieti, Italy
| | - Nico Adorante
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Stefano Giancaterino
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Clelia Di Carlo
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Saide Di Biase
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Consuelo Rosa
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Maria Daniela Falco
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy.
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Wei C, Qian P, Tedrow U, Mak R, Zei PC. Non-invasive Stereotactic Radioablation: A New Option for the Treatment of Ventricular Arrhythmias. Arrhythm Electrophysiol Rev 2020; 8:285-293. [PMID: 32685159 PMCID: PMC7358955 DOI: 10.15420/aer.2019.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Ventricular tachycardia (VT) is associated with significant morbidity and mortality. Radiofrequency catheter ablation can be effective for the treatment of VT but it carries a high rate of recurrence often attributable to insufficient depth of penetration for reaching critical arrhythmogenic substrates. Stereotactic body radioablation (SBRT) is a commonly used technology developed for the non-invasive treatment of solid tumours. Recent evidence suggests that it can also be effective for the treatment of VT. It is a non-invasive procedure and it has the unique advantage of delivering ablative energy to any desired volume within the body to reach sites that are inaccessible with catheter ablation. This article summarises the pre-clinical studies that have formed the evidence base for SBRT in the heart, describes the clinical approaches for SBRT VT ablation and provides perspective on next steps for this new treatment modality.
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Affiliation(s)
- Chen Wei
- Harvard Medical School, Boston, MA, US.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, US
| | - Pierre Qian
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, US
| | - Usha Tedrow
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, US
| | - Raymond Mak
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, US
| | - Paul C Zei
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, US
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18
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Radiation Therapy–Induced Dysfunction in Cardiovascular Implantable Electronic Devices. Pract Radiat Oncol 2019; 9:266-273. [DOI: 10.1016/j.prro.2019.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/28/2019] [Accepted: 03/13/2019] [Indexed: 11/18/2022]
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Prise en charge des patients porteurs de stimulateurs cardiaques ou défibrillateurs automatiques implantables traités par irradiation. Cancer Radiother 2018; 22:515-521. [DOI: 10.1016/j.canrad.2018.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 11/19/2022]
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20
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Rav Acha M, Corn BW. Revisiting the impact of radiation therapy on cardiac implantable electronic device (CIED) function. J Cardiovasc Electrophysiol 2018; 29:1276-1279. [DOI: 10.1111/jce.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Moshe Rav Acha
- Cardiology Department, Shaare Tzedek HospitalHebrew University Jerusalem Israel
| | - Ben W. Corn
- Radiation Oncology Department, Shaare Tzedek HospitalTel Aviv University School of Medicine Tel Aviv Israel
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21
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Spartalis M, Spartalis E, Athanasiou A, Nikiteas N. Safety concerns regarding ablative radiotherapy for ventricular tachycardia. Radiother Oncol 2018; 128:387. [PMID: 29937213 DOI: 10.1016/j.radonc.2018.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 06/04/2018] [Indexed: 01/25/2023]
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Bravo‐Jaimes K, Samala V, Fernandez G, Moravan MJ, Dhakal S, Shah AH, Messing S, Singh K, Aktas MK. CIED malfunction in patients receiving radiation is a rare event that could be detected by remote monitoring. J Cardiovasc Electrophysiol 2018; 29:1268-1275. [DOI: 10.1111/jce.13659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Katia Bravo‐Jaimes
- Department of CardiologyUniversity of Texas Health Science Center at Houston Houston TX USA
| | - Vikram Samala
- Department of MedicineCheshire Medical and Dartmouth‐Hitchcock Keene Keene NH USA
| | - Genaro Fernandez
- Department of CardiologyUniversity of Minnesota Minneapolis MN USA
| | - Michael J. Moravan
- Department of Radiation OncologyUniversity of Rochester Medical Center Rochester NY USA
| | - Sughosh Dhakal
- Department of Radiation OncologyUniversity of Rochester Medical Center Rochester NY USA
| | - Abrar H. Shah
- Sands Constellation Heart InstituteRochester Regional Health Rochester NY USA
| | - Susan Messing
- Department of Biostatistics and Computational BiologyUniversity of Rochester Rochester NY USA
| | - Kyra Singh
- Department of Biostatistics and Computational BiologyUniversity of Rochester Rochester NY USA
| | - Mehmet K. Aktas
- Department of CardiologyUniversity of Rochester Medical Center Rochester NY USA
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23
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Boriani G, Fauchier L, Aguinaga L, Beattie JM, Blomstrom Lundqvist C, Cohen A, Dan GA, Genovesi S, Israel C, Joung B, Kalarus Z, Lampert R, Malavasi VL, Mansourati J, Mont L, Potpara T, Thornton A, Lip GYH, Gorenek B, Marin F, Dagres N, Ozcan EE, Lenarczyk R, Crijns HJ, Guo Y, Proietti M, Sticherling C, Huang D, Daubert JP, Pokorney SD, Cabrera Ortega M, Chin A. European Heart Rhythm Association (EHRA) consensus document on management of arrhythmias and cardiac electronic devices in the critically ill and post-surgery patient, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin American Heart Rhythm Society (LAHRS). Europace 2018; 21:7-8. [DOI: 10.1093/europace/euy110] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/26/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | | | - James M Beattie
- Cicely Saunders Institute, King’s College London, London, UK
| | | | | | - Gheorghe-Andrei Dan
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”, Colentina University Hospital, Bucharest, Romania
| | - Simonetta Genovesi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano and Nephrology Unit, San Gerardo Hospital, Monza, Italy
| | - Carsten Israel
- Evangelisches Krankenhaus Bielefeld GmbH, Bielefeld, Germany
| | - Boyoung Joung
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice; Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Vincenzo L Malavasi
- Cardiology Division, Department of Nephrologic, Cardiac, Vascular Diseases, Azienda ospedaliero-Universitaria di Modena, Modena, Italy
| | - Jacques Mansourati
- University Hospital of Brest and University of Western Brittany, Brest, France
| | - Lluis Mont
- Arrhythmia Section, Cardiovascular Clínical Institute, Hospital Clinic, Universitat Barcelona, Barcelona, Spain
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | | | | | - Radosław Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Harry J Crijns
- Cardiology Maastricht UMC+ and Cardiovascular Research Institute Maastricht, Netherlands
| | - Yutao Guo
- Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Marco Proietti
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy
| | | | - Dejia Huang
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | | | - Sean D Pokorney
- Electrophysiology Section, Division of Cardiology, Duke University, Durham, NC, USA
| | - Michel Cabrera Ortega
- Department of Arrhythmia and Cardiac Pacing, Cardiocentro Pediatrico William Soler, Boyeros, La Havana Cuba
| | - Ashley Chin
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa
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24
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Management of patients with implanted cardiac devices during radiotherapy: results of a Spanish survey in radiation oncology departments. Clin Transl Oncol 2018; 20:1577-1581. [DOI: 10.1007/s12094-018-1893-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022]
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25
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Riva G, Alessandro O, Spoto R, Ferrari A, Garibaldi C, Cattani F, Luraschi R, Rondi E, Colombo N, Giovenzana FLF, Cipolla CM, Winnicki M, Persiani M, Castelluccia F, Fiore MS, Orecchia R, Jereczek-Fossa BA. Radiotherapy in patients with cardiac implantable electronic devices: clinical and dosimetric aspects. Med Oncol 2018; 35:73. [DOI: 10.1007/s12032-018-1126-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
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Zecchin M, Artico J, Morea G, Severgnini M, Bianco E, De Luca A, Fantasia AZ, Salvatore L, Milan V, Lucarelli M, Dissegna R, Cannatà A, Sinagra G. Radiotherapy and risk of implantable cardioverter-defibrillator malfunctions. J Cardiovasc Med (Hagerstown) 2018; 19:155-160. [DOI: 10.2459/jcm.0000000000000623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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27
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Zecchin M, Severgnini M, Fiorentino A, Malavasi VL, Menegotti L, Alongi F, Catanzariti D, Jereczek-Fossa BA, Stasi M, Russi E, Boriani G. Management of patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy: A consensus document from Associazione Italiana Aritmologia e Cardiostimolazione (AIAC), Associazione Italiana Radioterapia Oncologica (AIRO), Associazione Italiana Fisica Medica (AIFM). Int J Cardiol 2017; 255:175-183. [PMID: 29310933 DOI: 10.1016/j.ijcard.2017.12.061] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/04/2017] [Accepted: 12/19/2017] [Indexed: 11/15/2022]
Abstract
The management of patients with a cardiac implanted electronic device (CIED) receiving radiotherapy (RT) is challenging and requires a structured multidisciplinary approach. A consensus document is presented as a result of a multidisciplinary working group involving cardiac electrophysiologists, radiation oncologists and physicists in order to stratify the risk of patients with CIED requiring RT and approaching RT sessions appropriately. When high radiation doses and beam energy higher than 6MV are used, CIED malfunctions can occur during treatment. In our document, we reviewed the different types of RT and CIED behavior in the presence of ionizing radiations and electromagnetic interferences, from the cardiologist's, radiation oncologist's and medical physicist's point of view. We also reviewed in vitro and in vivo literature data and other national published guidelines on this issue so far. On the basis of literature data and consensus of experts, a detailed approach based on risk stratification and appropriate management of RT patients with CIEDs is suggested, with important implications for clinical practice.
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Affiliation(s)
- Massimo Zecchin
- Struttura Complessa di Cardiologia, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Mara Severgnini
- Struttura Complessa di Fisica Sanitaria, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Alba Fiorentino
- Unità Operativa Complessa di Radioterapia Oncologica, Ospedale Sacro Cuore-Don Calabria, Cancer Care Center Negrar, Verona, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Italy
| | - Loris Menegotti
- Servizio di Fisica Sanitaria, Azienda Provinciale per i Servizi Sanitari di Trento, Italy
| | - Filippo Alongi
- Unità Operativa Complessa di Radioterapia Oncologica, Ospedale Sacro Cuore-Don Calabria, Cancer Care Center Negrar, Verona (Italy) and Università di Brescia, Brescia, Italy
| | - Domenico Catanzariti
- Unità Operativa di Cardiologia, Azienda Provinciale per i Servizi Sanitari di Trento, Italy
| | - Barbara Alicja Jereczek-Fossa
- Divisione di Radioterapia, Istituto Europeo di Oncologia, Milano (Italy) and Dipartimento di Oncologia e Emato-oncologia dell'Università degli Studi di Milano, Milan, Italy
| | - Michele Stasi
- Struttura Complessa di Fisica Sanitaria, A.O. Ordine Mauriziano di Torino, Italy
| | - Elvio Russi
- Struttura Complessa di Radioterapia, Azienda Sanitaria Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Italy.
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28
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Yeung C, Chacko S, Glover B, Campbell D, Crystal E, Ben-Dov N, Baranchuk A. Radiotherapy for Patients with Cardiovascular Implantable Electronic Devices: A Review. Can J Cardiol 2017; 34:244-251. [PMID: 29395701 DOI: 10.1016/j.cjca.2017.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/16/2022] Open
Abstract
Because cardiovascular implantable electronic devices are increasingly indicated in older patients, and the burden of cancer is rising with the growth and aging of the world population, the management of patients with cardiac devices who require radiotherapy for cancer treatment is a timely concern. Device malfunctions might occur in as high as 3% of radiotherapy courses, posing a substantial issue in clinical practice. A nonsystematic comprehensive review was undertaken. We searched PubMed and the MEDLINE database for randomized controlled trials, meta-analyses, systematic reviews, observational studies, in vitro/in vivo studies, and case reports. Articles were selected by 2 independent reviewers, and emphasis was given to information of interest to a general medical readership. The pathophysiology and predictors of cardiovascular implantable electronic device malfunction due to radiotherapy are reviewed, recommendations for the management of patients with such devices undergoing radiotherapy are summarized, and the clinical significance and future directions of this field are discussed. Radiotherapy-induced device malfunctions are rare, but because of the potential complications, the development of evidence-based guidelines for the management of patients with cardiovascular implantable electronic devices undergoing radiotherapy is a timely concern.
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Affiliation(s)
- Cynthia Yeung
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Sanoj Chacko
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Benedict Glover
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Debra Campbell
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Eugene Crystal
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nissan Ben-Dov
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
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