1
|
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.
Collapse
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.)
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43:4229-4361. [PMID: 36017568 DOI: 10.1093/eurheartj/ehac244] [Citation(s) in RCA: 684] [Impact Index Per Article: 342.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
5
|
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
| |
Collapse
|
6
|
Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022; 23:e333-e465. [PMID: 36017575 DOI: 10.1093/ehjci/jeac106] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
7
|
Gulletta S, Falasconi G, Cianfanelli L, Centola A, Paglino G, Cireddu M, Radinovic A, D’Angelo G, Marzi A, Sala S, Fierro N, Bisceglia C, Peretto G, Di Muzio N, Della Bella P, Vergara P, Dell’Oca I. Patients with Cardiac Implantable Electronic Device Undergoing Radiation Therapy: Insights from a Ten-Year Tertiary Center Experience. J Clin Med 2022; 11:jcm11174990. [PMID: 36078921 PMCID: PMC9457044 DOI: 10.3390/jcm11174990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The number of patients with cardiac implantable electronic devices (CIEDs) receiving radiotherapy (RT) is increasing. The management of CIED-carriers undergoing RT is challenging and requires a collaborative multidisciplinary approach. Aim: The aim of the study is to report the real-world, ten-year experience of a tertiary multidisciplinary teaching hospital. Methods: We conducted an observational, real-world, retrospective, single-center study, enrolling all CIED-carriers who underwent RT at the San Raffaele University Hospital, between June 2010 and December 2021. All devices were MRI-conditional. The devices were programmed to an asynchronous pacing mode for patients who had an intrinsic heart rate of less than 40 beats per minute. An inhibited pacing mode was used for all other patients. All tachyarrhythmia device functions were temporarily disabled. After each RT session, the CIED were reprogrammed to the original settings. Outcomes included adverse events and changes in the variables that indicate lead and device functions. Results: Between June 2010 and December 2021, 107 patients were enrolled, among which 63 (58.9%) were pacemaker carriers and 44 (41.1%) were ICD carriers. Patients were subjected to a mean of 16.4 (±10.7) RT sessions. The most represented tumors in our cohort were prostate cancer (12; 11%), breast cancer (10; 9%) and lung cancer (28; 26%). No statistically significant changes in device parameters were recorded before and after radiotherapy. Generator failures, power-on resets, changes in pacing threshold or sensing requiring system revision or programming changes, battery depletions, pacing inhibitions and inappropriate therapies did not occur in our cohort of patients during a ten-year time span period. Atrial arrhythmias were recorded during RT session in 14 patients (13.1%) and ventricular arrhythmias were observed at device interrogation in 10 patients (9.9%). Conclusions: Changes in device parameters and arrhythmia occurrence were infrequent, and none resulted in a clinically significant adverse event.
Collapse
Affiliation(s)
- Simone Gulletta
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
- Correspondence:
| | - Giulio Falasconi
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Lorenzo Cianfanelli
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Alice Centola
- Centro Cardiologico Monzino, Via Carlo Parea 4, 20138 Milan, Italy
| | - Gabriele Paglino
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Manuela Cireddu
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Andrea Radinovic
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Giuseppe D’Angelo
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Alessandra Marzi
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Simone Sala
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Nicolai Fierro
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Caterina Bisceglia
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Giovanni Peretto
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Nadia Di Muzio
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Paolo Della Bella
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Pasquale Vergara
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Italo Dell’Oca
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| | | |
Collapse
|
10
|
Perioperative Management of Patients with Cardiac Implantable Electronic Devices and Utility of Magnet Application. J Clin Med 2022; 11:jcm11030691. [PMID: 35160149 PMCID: PMC8836758 DOI: 10.3390/jcm11030691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
With the demographic evolution of the population, patients undergoing surgery today are older and have an increasing number of sometimes complex comorbidities. Cardiac implantable electronic devices (CIED) are also getting more and more complex with very sophisticated programming algorithms. It may be generally assumed that magnet application reverts pacing to an asynchronous mode in pacemakers and disables tachycardia detection/therapy in internal cardioverter-defibrillators. However, depending on device type, manufacturer and model, the response to magnet application may differ substantially. For these reasons, perioperative management of CIED patients is getting more and more challenging. With this review article we provide an overview of optimal perioperative management of CIED patients with a detailed description of CIED response to magnet application depending on manufacturer and device-type, which may help in providing a safe perioperative management plan for the CIED patient.
Collapse
|
11
|
Escande A, Frey P, Lacornerie T, Mervoyer E, Chargari C, Laurans M, Mornex F, Marijon É, Giraud P. Radiotherapy for patient with cardiac implantable electronic device, consensus from French radiation oncology society. Cancer Radiother 2021; 26:404-410. [PMID: 34969621 DOI: 10.1016/j.canrad.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Radiotherapy in patients with cardiac implantable electronic device such as pacemakers or defibrillators, is a clinical situation that is becoming increasingly common. There is a risk of interaction between the magnetic field induced by accelerators and the cardiac implantable electronic device, but also a risk of device dysfunction due to direct and/or indirect irradiation if the cardiac implantable electronic device is in the field of treatment. The risk can be dose-dependent, but it is most often independent of the total dose and occurs randomly in case of neutron production (stochastic effect). The presence of this type of device is therefore described as a contraindication for radiotherapy by the French national agency for the safety of medicines and health products (Agence nationale de sécurité du médicament et des produits de santé, ANSM). Nevertheless, since radiotherapy is often possible, it is advisable to respect the recommendations of good practice, in particular the eligibility criteria, the monitoring modalities before, during and after irradiation according to the type of treatment, the dose and the characteristics of the cardiac implantable electronic device. It is sometimes necessary to discuss repositioning the device and/or modifying the treatment plan to minimize the risk of cardiac implantable electronic device dysfunction. We present the update of the recommendations of the French society of oncological radiotherapy on in patients with cardiac implantable electronic device.
Collapse
Affiliation(s)
- A Escande
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France; Faculté de médecine Henri-Warembourg, université de Lille, 59000 Lille, France; UMR 9189, Centre de recherche en informatique, signal et automatique de Lille (Cristal), 59655 Villeneuve d'Ascq, France.
| | - P Frey
- Département de cardiologie, centre hospitalier Annecy Genevois, 74370 Épagny-Metz-Tessy, France
| | - T Lacornerie
- Département de physique médicale, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - E Mervoyer
- Département de cardiologie, Institut de cancérologie de l'Ouest, 44800 Saint-Herblain, France
| | - C Chargari
- Unité de curiethérapie, département de radiothérapie, Gustave-Roussy, 94805 Villejuif, France
| | - M Laurans
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - F Mornex
- Département de radiothérapie, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France
| | - É Marijon
- Département de cardiologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Université de Paris, 20, rue Leblanc, 75015 Paris, France
| |
Collapse
|
12
|
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.
Collapse
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
| | | | | | | | | |
Collapse
|
13
|
Radiotherapy in patient with an automated implantable cardioverter defibrillator. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction:
An ever-growing number of patients with implantable cardiac rhythm devices are treated with radiation therapy for cancer and are therefore at risk of device failure. Several medical societies developed recommendations for the management of such patients.
We report the case of a 76-year-old patient with an implanted cardioverter defibrillator, treated with external radiotherapy for breast cancer, to test in practice the recommendations on the management of similar cases.
Collapse
|
14
|
Lee C, Maan A, Singh JP, Fradley MG. Arrhythmias and device therapies in patients with cancer therapy-induced cardiomyopathy. Heart Rhythm 2021; 18:1223-1229. [PMID: 33640446 DOI: 10.1016/j.hrthm.2021.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
Our knowledge of associated cardiotoxicities from novel therapeutics in oncology continues to expand. These include arrhythmias from cancer-therapy induced cardiomyopathy resulting from both direct and indirect effects on cardiomyocytes and other mechanisms that can adversely impact cardiovascular outcomes and overall mortality. In this review, we focus on both the arrhythmias of various classes of oncologic agents as well as the use of cardiac implantable electronic devices (cardioverter-defibrillators, permanent pacemakers, and cardiac resynchronization therapy) in cardio-oncology patients.
Collapse
Affiliation(s)
- Charlotte Lee
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Abhishek Maan
- Department of Cardiac Electrophysiology, The Mount Sinai Hospital, New York, New York
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
15
|
Levis M, Andreis A, Badellino S, Budano C, Caivano D, Cerrato M, Orlandi E, Bissolino A, Angelico G, Cavallin C, Giglioli FR, De Ferrari GM, Ricardi U. Safety of lung stereotactic ablative radiotherapy for the functioning of cardiac implantable electronic devices. Radiother Oncol 2021; 156:193-198. [PMID: 33387584 DOI: 10.1016/j.radonc.2020.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/21/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The prevalence of patients with a cardiac implantable device (CIED) developing cancer and requiring a course of radiotherapy (RT) is increasing remarkably. Previously published reports agree that standard and conventionally fractionated RT is usually safe for CIEDs, but no "in-vivo" reports are available on the potential effects of thoracic stereotactic ablative radiotherapy (SABR) regimens to CIEDs functioning. The purpose of our study is therefore to evaluate the effects of SABR on CIEDs (pacemakers [PM] or implantable cardiac defibrillators [ICD]) in a cohort of patients affected by primary or metastatic lung lesions. MATERIALS AND METHODS We retrospectively collected all CIED-bearing patients undergoing SABR between 2007 and 2019 at our Institution. All CIEDs were interrogated before and after the SABR course to check for any malfunction. Prescription dose, beam energy and maximum dose (Dmax) to CIEDs were retrieved for each patient. Electrical records of the CIEDs were reviewed by the medical records. RESULTS Thirty-four consecutive patients (24 with a PM and 10 with an ICD), who underwent 38 separate SABR courses, were included in the study. Eight patients (24%) were PM-dependent. Prescription dose of SABR ranged 26-60 Gy in 1-8 fractions, with a photon energy ranging 6-to-10 MV (76.3% and 23.7%, respectively) and a median Dmax to CIEDs of 0.17 Gy (range 0.04-1.97 Gy). Electrical parameters were stable in post-treatment device programming visits and no transient or persistent alteration of the CIED function was recorded in any patient. No inappropriate interventions were recorded in the 10 ICD-bearing patients during the treatment fractions. CONCLUSIONS Thoracic SABR proved to be safe for CIEDs when the dose is kept <2 Gy and the beam energy is ≤10 MV, irrespective of the pacing-dependency and of the CIED type.
Collapse
Affiliation(s)
- Mario Levis
- Department of Oncology, University of Torino, Italy.
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" Hospital, University of Torino, Italy
| | | | - Carlo Budano
- Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" Hospital, University of Torino, Italy
| | | | | | | | - Arianna Bissolino
- Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" Hospital, University of Torino, Italy
| | - Gloria Angelico
- Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" Hospital, University of Torino, Italy
| | | | | | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" Hospital, University of Torino, Italy
| | | |
Collapse
|