Radiotherapy for Patients with Cardiovascular Implantable Electronic Devices: A Review

Assessment of Radiation-Induced Malfunction in Cardiac Implantable Electronic Devices

“…To our knowledge, this is largest published series investigating CIED malfunctions in patients receiving RT. The 4% incidence of CIED malfunction and lack of association between radiation dose and malfunction are consistent with prior reported studies 10,15,[23][24][25][26] .…”

“…The results of this study suggest that CIED malfunctions are uncommon in centers that follow an algorithm of risk assessment for device management post radiation therapy. Furthermore, our results support the recent studies and expert consensus statements which have compellingly indicated that neutron-producing radiation and the associated beam energy are the strongest predictors of CIED malfunction 3,15,18,23,24 . The 2017 HRS expert consensus statement specifically states that non-neutron-producing treatment is preferred over neutron-producing treatment in patients with a CIED to minimize the risk of device reset; however, it does not address specifically whether/when to avoid beam energy ≥10 MV 9 .…”

“…The 4% incidence of CIED malfunction and the lack of association between radiation dose and malfunction are consistent with results of prior reported studies. 10 , 15 , 23 , 24 , 25 , 26 The results of this study suggest that CIED malfunctions are uncommon in centres that follow an algorithm of risk assessment for device management post–radiation therapy. Furthermore, our results support the recent studies and expert consensus statements that have compellingly indicated that neutron-producing radiation and the associated beam energy are the strongest predictors of CIED malfunction.…”

Safe Delivery of Endoscopic Brachytherapy in a Patient with a Dual Chamber Pacemaker

“…We estimate that the patient's device received a total cumulative dose of less than 25 cGy. In those who are pacing independent, a total cumulative radiation dose of less than 2 Gy is low risk for pacemaker dysfunction [6] .…”

“…The effect of scatter radiation on CIEDs is unclear, though small radiation doses (>2 Gy) are unlikely to result in predictable malfunction [10] . While the incidence of CIED complications due to radiotherapy is low, the rising population of patients with CIEDs requiring radiotherapy brings to attention the need for universal, evidence-based guidelines for the management of such patients [6] . A structured multidisciplinary approach involving collaboration between radiation oncology and cardiology is essential to minimize the incidence of device malfunction [11] .…”