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Al-Khatib SM. Cardiac Implantable Electronic Devices. N Engl J Med 2024; 390:442-454. [PMID: 38294976 DOI: 10.1056/nejmra2308353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Sana M Al-Khatib
- From the Division of Cardiology and the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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2
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Pons-Riverola A, Morillas H, Berdejo J, Pernas S, Pomares H, Asiain L, Garay A, Fernandez-Ortega A, Oliveira AC, Martínez E, Jiménez-Marrero S, Pina E, Fort E, Ramos R, Alcoberro L, Hidalgo E, Antonio-Rebollo M, Alcober L, Enjuanes Grau C, Comín-Colet J, Moliner P. Developing Cardio-Oncology Programs in the New Era: Beyond Ventricular Dysfunction Due to Cancer Treatments. Cancers (Basel) 2023; 15:5885. [PMID: 38136428 PMCID: PMC10742309 DOI: 10.3390/cancers15245885] [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: 11/24/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiovascular disease is a common problem in cancer patients that is becoming more widely recognized. This may be a consequence of prior cardiovascular risk factors but could also be secondary to the anticancer treatments. With the goal of offering a multidisciplinary approach to guaranteeing optimal cancer therapy and the early detection of related cardiac diseases, and in light of the recent ESC Cardio-Oncology Guideline recommendations, we developed a Cardio-Oncology unit devoted to the prevention and management of these specific complications. This document brings together important aspects to consider for the development and organization of a Cardio-Oncology program through our own experience and the current evidence.
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Affiliation(s)
- Alexandra Pons-Riverola
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Herminio Morillas
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Javier Berdejo
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Sonia Pernas
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Helena Pomares
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Clinical Haematology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Leyre Asiain
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Radiation Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Alberto Garay
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Adela Fernandez-Ortega
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Ana Carla Oliveira
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Clinical Haematology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Haematopoietic and Lymphoid Tumours Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Evelyn Martínez
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Radiation Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Radiobiology and Cancer Group, ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Elena Pina
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Thrombosis and Haemostasis Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Eduard Fort
- Pharmacy Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Raúl Ramos
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Lídia Alcoberro
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Encarnación Hidalgo
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
| | - Maite Antonio-Rebollo
- Oncogeriatrics Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Laia Alcober
- Primary Care Service Delta del Llobregat and IDIAP, Catalan Health Service, 08007 Barcelona, Spain;
| | - Cristina Enjuanes Grau
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Josep Comín-Colet
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Pedro Moliner
- Cardio-Oncology Unit, Bellvitge University Hospital—Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (A.P.-R.); (H.M.); (J.B.); (S.P.); (H.P.); (L.A.); (A.G.); (A.F.-O.); (A.C.O.); (E.M.); (S.J.-M.); (E.P.); (R.R.)
- Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (L.A.); (E.H.); (C.E.G.); (J.C.-C.)
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
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Qiao H, Jiang F, Ning P, Zhao H, Zhao J, Zhang J. Safety Review of Radiotherapy for Tumor Patients with Implantable Cardiac Pacemaker. ACTA CARDIOLOGICA SINICA 2023; 39:807-816. [PMID: 38022419 PMCID: PMC10646601 DOI: 10.6515/acs.202311_39(6).20230828a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/28/2023] [Indexed: 12/01/2023]
Abstract
Permanent pacemaker implantation is one of the most effective treatments for chronic arrhythmia. However, there is a certain risk associated with radiation therapy in cancer patients with implantable cardiac pacemakers. To prevent radiotherapy-induced pacemaker failure, there are established medical guidelines for the use of pacemakers in patients undergoing radiotherapy. With advancements in science and technology, the variety of available pacemakers has considerably increased, and radiotherapy equipment has also been updated. Given the variations in irradiation methods and the types of radiation used in clinical practice, there is a pressing need for international consensus on the regulations governing the use of cardiac pacemakers in cancer patients. Currently, many countries lack clinical guidelines for radiotherapy in cancer patients with cardiac pacemakers. This review summarizes recent reports and studies from PubMed (National Center for Biotechnology Information) regarding the safety of radiotherapy in cancer patients with implanted cardiac pacemakers, and provides valuable insights for clinical practice.
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Affiliation(s)
- Hongmei Qiao
- Department of Radiotherapy and Oncology, Baoji High-Tech Hospital, Baoji City, 721000, Shanxi, China
| | - Fan Jiang
- Department of Radiotherapy and Oncology, Baoji High-Tech Hospital, Baoji City, 721000, Shanxi, China
| | - Peng Ning
- Department of Radiotherapy and Oncology, Baoji High-Tech Hospital, Baoji City, 721000, Shanxi, China
| | - Hui Zhao
- Department of Radiotherapy and Oncology, Baoji High-Tech Hospital, Baoji City, 721000, Shanxi, China
| | - Jie Zhao
- Department of Radiotherapy and Oncology, Baoji High-Tech Hospital, Baoji City, 721000, Shanxi, China
| | - Jinru Zhang
- Department of Radiotherapy and Oncology, Baoji High-Tech Hospital, Baoji City, 721000, Shanxi, China
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4
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Bedi R, Ahmad A, Horbal P, Mar PL. Radiation-associated Arrhythmias: Putative Pathophysiological Mechanisms, Prevalence, Screening and Management Strategies. Arrhythm Electrophysiol Rev 2023; 12:e24. [PMID: 37680206 PMCID: PMC10481379 DOI: 10.15420/aer.2022.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/16/2023] [Indexed: 09/09/2023] Open
Abstract
Radiation-associated cardiovascular disease, an increasingly recognised disease process, is a significant adverse effect of radiation therapy for common malignancies that involve the chest, and include lymphomas, lung, mediastinal and breast cancers. Two factors contribute to the increasing incidence of radiation-associated cardiovascular disease: advances in malignancy detection and the improved survival of cancer patients, by which many symptoms of radiation-associated cardiovascular disease, specifically radiation-associated arrhythmias, present years and/or decades following initial radiotherapy. We present a focused overview of the currently understood pathophysiology, prevalence and management strategies of radiation-associated arrhythmias, which include bradyarrhythmias, tachyarrhythmias and autonomic dysfunction.
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Affiliation(s)
- Rohil Bedi
- Department of Internal Medicine, Saint Louis University School of Medicine St Louis, Missouri, US
| | - Ali Ahmad
- Department of Internal Medicine, Saint Louis University School of Medicine St Louis, Missouri, US
| | - Piotr Horbal
- Department of Internal Medicine, Saint Louis University School of Medicine St Louis, Missouri, US
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohio State University Columbus, Ohio, US
| | - Philip L Mar
- Division of Cardiology, Department of Internal Medicine, Saint Louis University School of Medicine St Louis, Missouri, US
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Leong DP, Cirne F, Aghel N, Baro Vila RC, Cavalli GD, Ellis PM, Healey JS, Whitlock R, Khalaf D, Mian H, Jolly SS, Mehta SR, Dent S. Cardiac Interventions in Patients With Active, Advanced Solid and Hematologic Malignancies: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2023; 5:415-430. [PMID: 37614581 PMCID: PMC10443114 DOI: 10.1016/j.jaccao.2023.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 08/25/2023] Open
Abstract
Invasive cardiac interventions are recommended to treat ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndromes, multivessel coronary disease, severe symptomatic aortic stenosis, and cardiomyopathy. These recommendations are based on randomized controlled trials that historically included few individuals with active, advanced malignancies. Advanced malignancies represent a significant competing risk for mortality, and there is limited evidence to inform the risks and benefits of invasive cardiac interventions in affected patients. We review the benefit conferred by invasive cardiac interventions; the periprocedural considerations; the contemporary survival expectations of patients across several types of active, advanced malignancy; and the literature on cardiovascular interventions in these populations. Our objective is to develop a rational framework to guide clinical recommendations on the use of invasive cardiac interventions in patients with active, advanced cancer.
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Affiliation(s)
- Darryl P. Leong
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Filipe Cirne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nazanin Aghel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Peter M. Ellis
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S. Healey
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard Whitlock
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dina Khalaf
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Sanjit S. Jolly
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shamir R. Mehta
- The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, North Carolina, USA
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Gevaert SA, Halvorsen S, Sinnaeve PR, Sambola A, Gulati G, Lancellotti P, Van Der Meer P, Lyon AR, Farmakis D, Lee G, Boriani G, Wechalekar A, Okines A, Asteggiano R, Combes A, Pfister R, Bergler-Klein J, Lettino M. Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Clinical Consensus Statement of the Acute CardioVascular Care Association (ACVC) and the ESC council of Cardio-Oncology—part 2: acute heart failure, acute myocardial diseases, acute venous thromboembolic diseases, and acute arrhythmias. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:865-874. [DOI: 10.1093/ehjacc/zuac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 12/05/2022]
Abstract
Abstract
Advances in treatment, common cardiovascular (CV) risk factors and the ageing of the population have led to an increasing number of cancer patients presenting with acute CV diseases. These events may be related to cancer itself or cancer treatment. Acute cardiac care specialists must be aware of these acute CV complications and be able to manage them. This may require an individualized and multidisciplinary approach. The management of acute coronary syndromes and acute pericardial diseases in cancer patients was covered in part 1 of a clinical consensus document. This second part focusses on acute heart failure, acute myocardial diseases, venous thromboembolic diseases and acute arrhythmias.
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Affiliation(s)
- Sofie A Gevaert
- Department of Cardiology, Ghent University Hospital , Gent , Belgium
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, and University of Oslo , Oslo , Norway
| | - Peter R Sinnaeve
- Department of Cardiology, University Hospital Leuven , Leuven , Belgium
| | - Antonia Sambola
- Department of Cardiology, University Hospital Vall d’Hebron, Universitat Autonòma, CIBER-CV , Barcelona , Spain
| | - Geeta Gulati
- Department of Cardiology, Oslo University Hospital Ulleval, and University of Oslo , Oslo , Norway
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Science, Department of Cardiology , CHU Sart Tilman, Liège , Belgium
| | - Peter Van Der Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Alexander R Lyon
- Cardio-Oncology Clinic at Royal Brompton Hospital and Imperial College London , London , UK
| | | | - Geraldine Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College , London , UK
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Policlinico Di Modena, Modena , Italy
| | - Ashutosh Wechalekar
- Department of Haematology, University College London/University College London Hospitals , London , UK
| | - Alicia Okines
- Department of Medicine, The Royal Marsden NHS Foundation Trust , London , UK
| | - Riccardo Asteggiano
- Insubria University , Varese , Italy
- LARC (Laboratorio Analisi e Ricerca Clinica) , Turin , Italy
| | - Alain Combes
- Medical-Surgical ICU, Hôpital Pitié–Salpêtrière , Paris , France
- Sorbonne University, Institute of Cardiometabolism and Nutrition , Paris , France
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University of Cologne , Cologne , Germany
| | - Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna , Vienna , Austria
| | - Maddalena Lettino
- Department of Cardiology, San Gerardo Hospital, ASST-Monza , Monza , Italy
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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.
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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
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8
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The impact of particle radiotherapy on the functioning of cardiac implantable electronic devices: a systematic review of in vitro and in vivo studies according to PICO criteria. Radiol Med 2022; 127:1046-1058. [PMID: 35871428 PMCID: PMC9508006 DOI: 10.1007/s11547-022-01520-6] [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: 01/20/2022] [Accepted: 06/20/2022] [Indexed: 12/24/2022]
Abstract
The number of oncological patients who may benefit from proton beam radiotherapy (PBT) or carbon ion radiotherapy (CIRT), overall referred to as particle radiotherapy (RT), is expected to strongly increase in the next future, as well as the number of cardiological patients requiring cardiac implantable electronic devices (CIEDs). The management of patients with a CIED requiring particle RT deserves peculiar attention compared to those undergoing conventional photon beam RT, mostly due to the potential generation of secondary neutrons by particle beams interactions. Current consensus documents recommend managing these patients as being at intermediate/high risk of RT-induced device malfunctioning regardless of the dose on the CIED and the beam delivery method used, despite the last one significantly affects secondary neutrons generation (very limited neutrons production with active scanning as opposed to the passive scattering technique). The key issues for the current review were expressed in four questions according to the Population, Intervention, Control, Outcome criteria. Three in vitro and five in vivo studies were included. Based on the available data, PBT and CIRT with active scanning have a limited potential to interfere with CIED that has only emerged from in vitro study so far, while a significant potential for neutron-related, not severe, CIED malfunctions (resets) was consistently reported in both clinical and in vitro studies with passive scattering.
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9
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Koutroumpakis E, Deswal A, Yusuf SW, Abe JI, Nead KT, Potter AS, Liao Z, Lin SH, Palaskas NL. Radiation-Induced Cardiovascular Disease: Mechanisms, Prevention, and Treatment. Curr Oncol Rep 2022; 24:543-553. [PMID: 35192118 DOI: 10.1007/s11912-022-01238-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Despite the advancements of modern radiotherapy, radiation-induced cardiovascular disease (RICVD) remains a common cause of morbidity and mortality among cancer survivors. RECENT FINDINGS Proposed pathogenetic mechanisms of RICVD include endothelial cell damage with accelerated atherosclerosis, pro-thrombotic alterations in the coagulation pathway as well as inflammation and fibrosis of the myocardial, pericardial, valvular, and conduction tissues. Prevention of RICVD can be achieved by minimizing the exposure of the cardiovascular system to radiation, by treatment of underlying cardiovascular risk factors and cardiovascular disease, and possibly by prophylactic pharmacotherapy post exposure. Herein we summarize current knowledge on the mechanisms underlying the pathogenesis of RICVD and propose prevention and treatment strategies.
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Affiliation(s)
- Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Anita Deswal
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Syed Wamique Yusuf
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Jun-Ichi Abe
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Kevin T Nead
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S Potter
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Division of Cardiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicolas L Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
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