Katia Bravo-Jaimes1, Vikram Samala2, Genaro Fernandez3, Michael J Moravan4, Sughosh Dhakal4, Abrar H Shah5, Susan Messing6, Kyra Singh6, Mehmet K Aktas7. 1. Department of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, USA. 2. Department of Medicine, Cheshire Medical and Dartmouth-Hitchcock Keene, Keene, NH, USA. 3. Department of Cardiology, University of Minnesota, Minneapolis, MN, USA. 4. Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA. 5. Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA. 6. Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA. 7. Department of Cardiology, University of Rochester Medical Center, Rochester, NY, USA.
Abstract
INTRODUCTION: An increasing number of patients with cardiac devices require radiation therapy for treatment of a variety of cancers. This study aimed to identify the incidence and predictors of cardiac implantable electronic devices (CIED) malfunction in a real-world population that has received radiation therapy. METHODS: This retrospective cohort study included 109 adult patients who received radiation therapy at the University of Rochester Medical Center, Radiation Oncology Department, between 2000 and 2015. Sixty patients had pacemakers and 49 had automatic implantable cardioverter defibrillators. Subjects received either high energy (16 MV) and/or low energy (6 MV) photon beams with or without electron beams (6-16 MeV). We included interrogations done from first day of radiation and up to 3 months' postradiation therapy. Outcomes analyzed were device-related malfunctions and device-related clinical events. Fisher's exact, Wilcoxon, and Kruskall-Wallis tests were used for bivariate analysis. Logistic regression with robust adjustment was used for multivariate analysis. RESULTS: We identified six device-related malfunctions. All events were minor and included partial settings reset leading to loss of historical data, pacing thresholds changes, lead impedance changes, and LV output increase. Two patients had device-related clinical events, including dyspnea and diaphragmatic-stimulation. In bivariate analysis, CIED malfunction was associated with CIED duration in situ. In multivariate analysis, there was no significant statistical association between adverse events and beam energy type, CIED location, or dose of radiation delivered to the target. CONCLUSIONS: CIED malfunctions are uncommon in real-world patients and associated with minor clinical events. In our cohort, remote CIED monitoring would have identified all events.
INTRODUCTION: An increasing number of patients with cardiac devices require radiation therapy for treatment of a variety of cancers. This study aimed to identify the incidence and predictors of cardiac implantable electronic devices (CIED) malfunction in a real-world population that has received radiation therapy. METHODS: This retrospective cohort study included 109 adult patients who received radiation therapy at the University of Rochester Medical Center, Radiation Oncology Department, between 2000 and 2015. Sixty patients had pacemakers and 49 had automatic implantable cardioverter defibrillators. Subjects received either high energy (16 MV) and/or low energy (6 MV) photon beams with or without electron beams (6-16 MeV). We included interrogations done from first day of radiation and up to 3 months' postradiation therapy. Outcomes analyzed were device-related malfunctions and device-related clinical events. Fisher's exact, Wilcoxon, and Kruskall-Wallis tests were used for bivariate analysis. Logistic regression with robust adjustment was used for multivariate analysis. RESULTS: We identified six device-related malfunctions. All events were minor and included partial settings reset leading to loss of historical data, pacing thresholds changes, lead impedance changes, and LV output increase. Two patients had device-related clinical events, including dyspnea and diaphragmatic-stimulation. In bivariate analysis, CIED malfunction was associated with CIED duration in situ. In multivariate analysis, there was no significant statistical association between adverse events and beam energy type, CIED location, or dose of radiation delivered to the target. CONCLUSIONS: CIED malfunctions are uncommon in real-world patients and associated with minor clinical events. In our cohort, remote CIED monitoring would have identified all events.
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
Authors: Tinh Le; James Neuenschwander; Parker Cordial; Mackenzie Sankoe; Ankur Parekh; Brian Hiestand; W F Peacock Journal: Clin Exp Emerg Med Date: 2022-03-31