Radiotherapy is safe in patients with implantable cardiac devices. Analysis of a systematic interrogation follow-up

Lopez-Honrubia, Veronica; Hidalgo-Olivares, Víctor M.; Dobón-Roux, M; Marti-Laosa, M. Magdalena; Castro-Larefors, S; Fernández-López, Jesús; Andrés, Ignacio; Roche, Olga; Rovirosa, Á.; Arenas, Meritxell; Martinez-Terol, F; Fernández, Teresa López; Sabater, S.

doi:10.1007/s12094-020-02374-y

Cited by 6 publications

(14 citation statements)

References 22 publications

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“…Our study shows that the prevalence of RT‐associated CIEDs malfunctions is variable, and this suggests the need for risk stratification on the basis of factors related to the patient, the type of CIED, and the RT procedure. However, it is noteworthy that according to literature only three reported CIED malfunctions were classified as potentially life‐threatening, thus highlighting the overall safety profile of RT even in this subset of patients 38 . Our analysis showed a pooled proportion of malfunction probably higher than what reported in a European Heart Rhythm Association survey 44 where approximately 1/3 of the 36 respondent centres reported no malfunction, 1/3 reported malfunction in 2% of the irradiated patients and 11% malfunction in 5%.…”

Section: Discussionmentioning

confidence: 48%

“…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: Discussionmentioning

confidence: 48%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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“… 35 A recent study also reported that adverse clinical events can occur in any group of risk and no dose-dependency was observed on the CIED malfunction. 36 Another study confirmed that lung stereotactic ablative radiation therapy is safe for CIEDs when the dose is kept <2 Gy and beam energy is <10 MV, regardless of the pacing-dependency and the CIED type. 37 A retrospective study found that all single-event upset malfunctions occurred in the setting of neutron production, with 21% for neutron-producing RT (ie, 15 MV or 18 MV) and 0% for non–neutron-producing RT (ie, electrons, Gamma Knife, or 6 MV).…”

Section: Management Of Commonly Seen Implanted Devices In Rt Patientsmentioning

confidence: 86%

A Review and Analysis of Managing Commonly Seen Implanted Devices for Patients Undergoing Radiation Therapy

Chan

Young

Gelblum

et al. 2021

Advances in Radiation Oncology

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Purpose This review article aims to consolidate information regarding existing and emerging implanted devices used in patients undergoing radiation therapy and to categorize levels of attention needed for each device, including which devices require monitoring throughout treatment. Methods and Materials Based on the collective information from scholar searches, manufacturers’ technical reports, and institutional experiences in the past years, commonly present devices in patients with cancer are compiled. This work summarizes cardiac pacemaker, implanted cardiac defibrillator, hepatic pump, intrathecal pain pump, neurostimulator, shunt, loop recorder, and mediport. Three different classifications of implanted devices can be made based on the potential effect of radiation: life-dependent, nonlife-dependent but with adverse effects if overdosed, and devices without electronic circuits. Implanted devices that contain electronic circuits that would be life-dependent or have adverse effects if overdosed, include cardiac pacemakers, implanted cardiac defibrillators, programmable hepatic pumps, pain pumps, neurostimulators, and loop recorders. Results Dose exposure to these devices need to be calculated or measured in vivo , especially for cardiac implanted devices, and they should be minimized to assure continued healthy functioning. Treatment planning techniques should be chosen to reduce entry, exit and internal scatter dose. Lower energy photon beams should be used to decrease potential neutron contamination. Implanted devices without electronic circuits are less of a concern. If a patient is life-dependent on the implanted device, it is not recommended to treat the patient with proton therapy. Conclusions This study reviewed the management of patients with commonly seen implanted devices and summarized a workflow for identifying and planning when a patient has implanted devices. Classifications of implanted devices could help clinicians make proper decisions in regard to patients with specific implanted devices. Lastly, the management of such devices in the era of the pandemic is also discussed in this review article.

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Radiotherapy-induced malfunctions of cardiac implantable electronic devices: A meta-analysis

Wang

Tse

et al. 2023

Heart Rhythm

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Radiotherapy is safe in patients with implantable cardiac devices. Analysis of a systematic interrogation follow-up

Cited by 6 publications

References 22 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

A Review and Analysis of Managing Commonly Seen Implanted Devices for Patients Undergoing Radiation Therapy

Radiotherapy-induced malfunctions of cardiac implantable electronic devices: A meta-analysis

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