Radiation-induced effects in multiprogrammable pacemakers and implantable defibrillators.

Twenty-three multiprogrammable pacemakers and four implantable cardioverter defibrillators (ICDs) containing either complementary metal-oxide semiconductor (CMOS) or CMOS/Bipolar integrated circuit (IC) technology were exposed to 6-MV photon and 18-MeV electron radiation at various dose levels. Of the 17 pacemakers exposed to photon radiation eight failed before 50 Gy, whereas four of the six pacemakers exposed to electron radiation failed before 70 Gy. Photon scatter doses were well tolerated. For the ICDs detection and charging time increased with accumulated radiation dose, the charging time increased catastrophically at less than 50 total pulses delivered when compared with the charging time of six implanted ICDs. Sensitivity and output energy delivered by the ICD pulse were constant during the test. It was found that devices using the shorter channel length IC technology (i.e., 3 microns CMOS) were per se harder to ionizing radiation than the devices using larger channel length IC technologies (i.e., either 8 microns CMOS or combined 5 microM CMOS/20 V Bipolar). In fact, none of the devices based on 3 microns CMOS IC technology failed before 76 Gy, which is above the highest dose level (70 Gy) normally used in radiation oncology treatments.