Radiation therapy in patients with cardiac implantable electronic devices

Niedziela, Jacek; Blamek, Sławomir; Gadula‐Gacek, Elżbieta; Gorol, Jarosław; Klinke, Anna; Witek, Mateusz; Wojtaszczyk, Adam; Plaza, Przemysław; Miszczyk, Leszek; Gąsior, Mariusz; Tajstra, Mateusz

doi:10.33963/kp.15705

Cited by 6 publications

(17 citation statements)

References 17 publications

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“…Relevant citations were assessed following the Patient/Population, Intervention, Comparison, Outcomes (PICO) process. Thirty‐two papers matched the inclusion/ exclusion criteria and were included in the present meta‐analysis 12–43 . Figure 1 summarizes the study selection process.…”

Section: Resultsmentioning

confidence: 99%

“…Among the 32 studies considered, 13 (41%) were prospective 12,14–19,21,22,24,33,37,40 and 19 (59%) were retrospective 13,20,23,25–32,34–36,38,39,41–43 . With regard to CIED type, PM/CRT‐P were considered in 28 studies, 13,14,16–21,23–26,28–43 ICD in 29 studies 12,13,15,16,19–43 and CRT‐D in 12 studies 22,24,25,28–30,32–34,37,39,43 . Publication years ranged from 2002 to 2021.…”

Section: Resultsmentioning

confidence: 99%

“…In 25 studies (3018 patients), it was possible to compare PM/CRT‐P versus ICD/CRT‐D 13,16,19–21,23–26,28–43 . The meta‐analysis showed a risk ratio of 2.07 (95% CI: 1.40–3.06) for malfunctions in ICD/CRT‐D patients when compared to PM/CRT‐P patients (Figure 3, Panel B), with low heterogeneity ( I 2 = 1%).…”

Section: Resultsmentioning

confidence: 99%

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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

Malavasi

Imberti

Tosetti

et al. 2022

Eur J Clin Investigation

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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

Malavasi

Imberti

Tosetti

et al. 2022

Eur J Clin Investigation

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“…The second malfunction mechanism, the electromagnetic interference, can lead to signal disturbances resulting in altered sensing or stimulation. In literature, a rare case is reported in which a patient undergoing RT for a tumor in the neck area received an inappropriate shock from the ICD, following an incorrect ventricular fibrillation detection because of T-wave oversensing [ 7 ]. Another effect of electromagnetic interference can be the full reset of the device or, in the worst-case scenario, the complete device failure, which can be a life-threatening condition in pacemaker-dependent patients.…”

Section: Discussionmentioning

confidence: 99%

Patients with Cardiac Implantable Electronic Device Undergoing Radiation Therapy: Insights from a Ten-Year Tertiary Center Experience

Gulletta

Falasconi

Cianfanelli

et al. 2022

JCM

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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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“…During 5872 radiotherapy sessions, 2 harmful interactions were recorded, and they are discussed in detail in a separate study. 19 The number of patients with CIEDs per year, their baseline characteristics, and radiotherapy location are presented in FIGURe 3.…”

Section: Conditionmentioning

confidence: 99%

Two professions against two killer diseases: the rationale, organization, and initial experience of a cardio-oncology service

et al. 2021

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Background Cardiovascular diseases are the most common factor affecting prognosis in cancer survivors. Cardio -oncology (CO) services have been developed to solve this issue. The outcomes regarding patient demographics and clinical findings are limited and the available data include CO services evaluating patients undergoing only chemotherapy as opposed to those also undergoing radiation therapy. aims We aimed to show initial experiences of the CO service implemented in a tertiary oncology center. methods The CO service was designed to include 2 major domains, general CO and electrotherapy consultations. This observational study included patients referred to the CO service with the following data: baseline demographics, cancer type, reasons for referral, cardiac evaluation, and initial clinical outcomes. results All patients with cancer referred to our CO service between March 2016 and December 2019 were included in the study. A total of 2762 patients (77% women) at the mean (SD) age of 62 (12) years were referred (63% on an out -patient basis) for general consultations. The most frequent diagnosis was breast cancer (66%). A total of 18% of patients were referred to the CO service due to cardiovascular complications related to cancer treatment. The CO-cardiac implantable electronic device (CIED) team evaluated 652 patients (515 patients with CIEDs who were qualified for radiotherapy, 48 patients with CIEDs who were assessed with magnetic resonance imaging, and 89 patients with CIEDs who underwent cancer surgery). In the total of 5872 radiotherapy sessions, there were 2 harmful interactions; no other complications during magnetic resonance imaging and surgery were recorded. conclusions The CO -service established within the cancer center seems to be safe and feasible.

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Radiation therapy in patients with cardiac implantable electronic devices

Cited by 6 publications

References 17 publications

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

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

Patients with Cardiac Implantable Electronic Device Undergoing Radiation Therapy: Insights from a Ten-Year Tertiary Center Experience

Two professions against two killer diseases: the rationale, organization, and initial experience of a cardio-oncology service

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