Radiation Therapy with Implanted Cardiac Pacemaker Devices: a Clinical and Dosimetric Analysis of Patients and Proposed Precautions

Wadasadawala, Tabassum; Pandey, Avinash; Agarwal, Jitendra; Jalali, Rakesh; Laskar, Siddhartha; Chowdhary, Sajeel; Budrukkar, Ashwini; Sarin, Rajiv; Deshpande, Deepak D.; Munshi, Anusheel

doi:10.1016/j.clon.2010.08.031

Cited by 44 publications

(56 citation statements)

References 11 publications

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“…In the same paper, they reported that they did not find any defects during an in vitro study of 20 ICDs irradiated to a dose of 4 Gy. Wadasadawala et al reported on 8 pacemaker patients receiving a cumulative dose of 0.14-60 Gy to the pacemaker and found no defects with a median follow-up of 5 months [3]. Gelblum et al reported on 33 patients with an ICD, with dose to ICD ranging from 1 cGy to 300 cGy [37].…”

Section: Methodsmentioning

confidence: 99%

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

et al. 2012

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Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient’s perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients’ perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well.

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Section: Methodsmentioning

confidence: 99%

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

et al. 2012

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“…Cardiac implantable electronic devices are composed of, and can be contoured into, many different sections . The electronically sensitive component of the device is the body.…”

Section: Patient Management and Recommendationsmentioning

confidence: 99%

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

et al. 2019

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Managing radiotherapy patients with implanted cardiac devices (implantable cardiac pacemakers and implantable cardioverter‐defibrillators) has been a great practical and procedural challenge in radiation oncology practice. Since the publication of the AAPM TG‐34 in 1994, large bodies of literature and case reports have been published about different kinds of radiation effects on modern technology implantable cardiac devices and patient management before, during, and after radiotherapy. This task group report provides the framework that analyzes the potential failure modes of these devices and lays out the methodology for patient management in a comprehensive and concise way, in every step of the entire radiotherapy process.

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“…97–99 Exposure to therapeutic radiation has been associated with pacing inhibition, inappropriate tracking, noise-reversion, inappropriate shocks, CIEDs failure, and runaway pacing with induction of potentially life-threatening ventricular arrhythmias. 73, 74, 100 The cumulative effect of ionizing radiation on the oxide layers of CMOS circuits utilized in CIEDs 75 vary depending on the type (photon vs. proton based therapy), dose measured as energy absorbed per mass with units of joule per kilogram or gray (Gy), direction of radiation, and device type and location. 101, 102 A dose range as wide as 0.5 to 120 Gy could be associated with ICD failure.…”

Section: Radiotherapy and Ionizing Radiationmentioning

confidence: 99%

Effects of External Electrical and Magnetic Fields on Pacemakers and Defibrillators

2013

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Radiation Therapy with Implanted Cardiac Pacemaker Devices: a Clinical and Dosimetric Analysis of Patients and Proposed Precautions

Cited by 44 publications

References 11 publications

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

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

Effects of External Electrical and Magnetic Fields on Pacemakers and Defibrillators

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Radiation Therapy with Implanted Cardiac Pacemaker Devices: a Clinical and Dosimetric Analysis of Patients and Proposed Precautions

Cited by 44 publications

References 11 publications

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

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

Effects of External Electrical and Magnetic Fields on Pacemakers and Defibrillators

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