Management of patients with implantable cardioverter-defibrillators and pacemakers who require radiation therapy

Brambatti, Michela; Mathew, Rebecca; Strang, Barbara; Dean, Joan; Goyal, Anuja; Hayward, Joseph E.; Long, Laurene; DeMeis, Patty; Smoke, Marcia; Connolly, Stuart J.; Morillo, Carlos A.; Amit, Guy; Capucci, Alessandro; Healey, Jeff S.

doi:10.1016/j.hrthm.2015.06.003

Cited by 60 publications

(50 citation statements)

References 21 publications

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“…15 These studies report an incidence of RT attributable CIED abnormalities ranging from 1.5% to 7% 10,16,17 with the most commonly identified CIED mal- show that CIED malfunction is a rare event and that many of the events seen in our series, as well as those reported in other series, can be monitored and detected through contemporary remote CIED monitoring systems. 15 These studies report an incidence of RT attributable CIED abnormalities ranging from 1.5% to 7% 10,16,17 with the most commonly identified CIED mal- show that CIED malfunction is a rare event and that many of the events seen in our series, as well as those reported in other series, can be monitored and detected through contemporary remote CIED monitoring systems.…”

Section: Discussionsupporting

confidence: 58%

CIED malfunction in patients receiving radiation is a rare event that could be detected by remote monitoring

Bravo‐Jaimes

Samala

Fernandez

et al. 2018

Cardiovasc electrophysiol

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Section: Discussionsupporting

confidence: 58%

CIED malfunction in patients receiving radiation is a rare event that could be detected by remote monitoring

Bravo‐Jaimes

Samala

Fernandez

et al. 2018

Cardiovasc electrophysiol

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“…While all patients in our study received checks to their ICD at the conclusion of treatment, it is possible that any device malfunctions occurring in the days to weeks following treatment conclusion are not accounted for in this study. Long‐term effects on the devices were not studied …”

Section: Discussionmentioning

confidence: 99%

A review of implantable cardioverter defibrillator failures during radiation therapy in three Sydney hospitals

Hudson

Ryan

2017

J Med Imag Rad Onc

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Introduction: In recent years, using radiation energies greater than 10 MV in patients with implantable cardioverter defibrillators (ICDs) has been contraindicated due to the risk of a power on reset (POR) occurring. The ICD is often greater than 30 cm from the treatment field and subject to scatter radiation only. The aim of this study was to use recent patient cases to verify published failure rates and treatment recommendations. Method: Five patients with ICDs who experienced a device malfunction during radiation therapy treatments were identified in three Sydney hospitals between 2008 and 2012. The types of treatments delivered during these events were assessed. Further assessment of all ICD patients at one Sydney hospital during this time was carried out to assess the rate of ICD failure during high energy treatments using 18 MV. Results: All ICDs that suffered malfunctions were exposed to scatter radiation only. All were exposed to partial or exclusive irradiation using 18 MV photons. Accumulated doses to the ICDs were estimated to be well below accepted dose limits found in literature. One centre reported a 22.2% rate of POR during exposure to 18 MV radiation therapy during this time frame. Conclusions: Where possible, radiation therapy using energies greater than 10 MV should be avoided for ICD patients. While the use of these energies carries a risk of failure, it must be weighed against potential benefit to the patient requiring treatment if no alternatives are available. Stringent monitoring of these patients, including regular cardiac device checks and ECG monitoring is recommended if treatment is to proceed with energies greater than 10 MV.

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“…In particular, it has been shown that neutron‐producing radiotherapy, especially >10 MV, is associated with malfunction of contemporary implantable cardiac devices (ICDs and pacemakers) . Use of a systematic policy of risk assessment and patient management is important in minimizing device‐related complications …”

Section: Discussionmentioning

confidence: 99%

Safe delivery of lung stereotactic body radiation therapy in a patient with a left ventricular assist device and implantable cardioverter defibrillator

Ostertag‐Hill

Mudd

Werle

et al. 2018

Clinical Case Reports

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Management of patients with implantable cardioverter-defibrillators and pacemakers who require radiation therapy

Cited by 60 publications

References 21 publications

CIED malfunction in patients receiving radiation is a rare event that could be detected by remote monitoring

CIED malfunction in patients receiving radiation is a rare event that could be detected by remote monitoring

A review of implantable cardioverter defibrillator failures during radiation therapy in three Sydney hospitals

Safe delivery of lung stereotactic body radiation therapy in a patient with a left ventricular assist device and implantable cardioverter defibrillator

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