Michela Brambatti1, Rebecca Mathew2, Barbara Strang3, Joan Dean4, Anuja Goyal5, Joseph E Hayward3, Laurene Long4, Patty DeMeis3, Marcia Smoke3, Stuart J Connolly5, Carlos A Morillo5, Guy Amit5, Alessandro Capucci6, Jeff S Healey5. 1. Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, Ancona, Italy. Electronic address: michelabrambatti@gmail.com. 2. Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada. 3. Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada. 4. Hamilton Health Sciences, Hamilton, Ontario, Canada. 5. Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. 6. Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, Ancona, Italy.
Abstract
BACKGROUND: Radiation therapy (RT) may pose acute and long-term risks for patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). However, the frequency of these problems has not been accurately defined. OBJECTIVE: The purpose of this study was to determine the prevalence of CIEDs among patients requiring RT and report the common CIED-related problems when patients are managed according to a standard clinical care path. METHODS: In a single tertiary-care center, we prospectively screened all patients requiring RT and identified patients with ICDs or PMs. We collected clinical data about their cancer, RT treatment plan, and CIED. Radiation dose to the device was estimated in all patients, and any device malfunction during RT was documented. RESULTS: Of the 34,706 consecutive patients receiving RT, 261 patients (0.8%, mean age 77.9 ± 9.4 years) had an implantable cardiac device: 54 (20.7%) ICDs and 207 (79.3%) PMs. The site of RT was head and neck (27.4%), chest (30.0%), and abdomen/pelvis (32.6%). Using our care path, 63.2% of patients required continuous cardiac monitoring, 14.6% required device reprogramming, 18.8% required magnet application during RT, and 3.4% required device repositioning to the contralateral side before RT. Four patients (1.5%) had inappropriate device function during RT: 3 experienced hemodynamically tolerated ventricular pacing at the maximum sensor rate, and 1 experienced a device power-on-reset. No patient died or suffered permanent device failure. CONCLUSION: Nearly 1% of patients receiving RT in this series has a PM or ICD. However, with a systematic policy of risk assessment and patient management, significant device-related complications are rare.
BACKGROUND: Radiation therapy (RT) may pose acute and long-term risks for patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). However, the frequency of these problems has not been accurately defined. OBJECTIVE: The purpose of this study was to determine the prevalence of CIEDs among patients requiring RT and report the common CIED-related problems when patients are managed according to a standard clinical care path. METHODS: In a single tertiary-care center, we prospectively screened all patients requiring RT and identified patients with ICDs or PMs. We collected clinical data about their cancer, RT treatment plan, and CIED. Radiation dose to the device was estimated in all patients, and any device malfunction during RT was documented. RESULTS: Of the 34,706 consecutive patients receiving RT, 261 patients (0.8%, mean age 77.9 ± 9.4 years) had an implantable cardiac device: 54 (20.7%) ICDs and 207 (79.3%) PMs. The site of RT was head and neck (27.4%), chest (30.0%), and abdomen/pelvis (32.6%). Using our care path, 63.2% of patients required continuous cardiac monitoring, 14.6% required device reprogramming, 18.8% required magnet application during RT, and 3.4% required device repositioning to the contralateral side before RT. Four patients (1.5%) had inappropriate device function during RT: 3 experienced hemodynamically tolerated ventricular pacing at the maximum sensor rate, and 1 experienced a device power-on-reset. No patient died or suffered permanent device failure. CONCLUSION: Nearly 1% of patients receiving RT in this series has a PM or ICD. However, with a systematic policy of risk assessment and patient management, significant device-related complications are rare.
Authors: Vincenzo L Malavasi; Giuseppina De Marco; Jacopo F Imberti; Filippo Placentino; Marco Vitolo; Ercole Mazzeo; Gianfranco Cicoria; Edoardo Casali; Vincenzo Turco; Frank Lohr; Giuseppe Boriani Journal: Intern Emerg Med Date: 2019-12-02 Impact factor: 3.397