A National Audit of Current Cardiac Device Policies from Radiotherapy Centres across the UK

Abstract

Aims: The number of patients with cardiac implantable electronic devices (permanent pacemakers and implantable cardioverter defibrillators) undergoing radiotherapy treatment is increasing. The aims of this audit were to establish current UK practice regarding the management of patients with implanted cardiac devices undergoing radiotherapy and to compare this practice with current 'gold standard' evidence-based guidelines. Materials and methods: All UK radiotherapy departments were contacted and asked to provide their current cardiac implantable electronic device policy or to indicate if there was no current policy. A proforma was created to analyse these polices and to compare with current best practice. Results: In total, 47/67 (70%) radiotherapy departments responded and 45 departmental policies were submitted; 31/45 (69%) policies defined the radiotherapy tolerance dose to permanent pacemakers and 14/45 (31%) defined the monitoring procedure for patients in line with current best practice. Only 5/45 (11%) policies defined the radiotherapy tolerance dose to implantable cardioverter defibrillators and 12/45 (27%) defined the monitoring procedure in line with current best practice. Conclusion: Most UK cardiac device policies do not reflect current best evidence. Policies are based on research carried out in

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203†

“…A mere 35% monitor the patient during treatment and only 20% of the clinics perform in vivo dose measurements regularly. Similar inconsistent or insufficient practices were observed by Lester et al based on a survey across the United Kingdom, and by Soejima et al, in a survey of centers in Japan. Gossman et al, in a retrospective physicians’ survey on treatment approach, delivery and follow‐up for management of RT patients with CIEDs, concluded that most radiation oncologists were unfamiliar with the recommended standard of practice by the AAPM, and the involvement of the medical physicist (MP) with patient management, finding both to be insufficient.…”

“…In case this is not known prior to consultation, the patient should be asked during the first visit to the RT facility. The patient (or patient’s legal representative) consent should be obtained in which that person is educated and notified about the potential adverse effects of RT on CIEDs and that an ICD might be deactivated during RT …”

Risk of Device Malfunction in Cancer Patients with Implantable Cardiac Device Undergoing Radiotherapy: A Population‐Based Cohort Study

“…The fraction of RT courses leading to an additional PM/ICD evaluation was relatively low. Lester et al recently reported that 76% of RT departments in the UK require cardiology assessment in this patient group according to their policies. Meanwhile, back in 2004, only 37% of RT departments in North America had a practice of consulting cardiologists during RT in PM/ICD patients …”

“…Ionizing radiation used in cancer external beam radiotherapy (RT) can damage electronic heart rhythm devices, potentially threatening the safety of the patient . The number of patients with a pacemaker (PM) or an implantable cardioverter defibrillator (ICD) undergoing RT is assumed to be increasing . However, very little is known about the exact size of this population and temporal developments in its magnitude.…”

“…The official international guidelines for safe RT in PM/ICD patients were published in 1994 and have not been updated since . Although there have been many review articles including practical recommendations, considerable differences still exist in the use of safety measures during RT in these patients . Recommendations by PM/ICD manufacturers vary as well …”