Maria Daniela Falco1, Domenico Genovesi2, Luciana Caravatta2, Clelia Di Carlo2, Ekaterina Bliakharskaia3, Marianna Appignani4, Massimiliano Faustino5, Nanda Furia5, Enrico Di Girolamo5. 1. Department of Radiation Oncology, "SS. Annunziata" Hospital, "G. D'Annunzio" University, Via De' Vestini, 66100, Chieti, Italy. mdanielafalco@hotmail.com. 2. Department of Radiation Oncology, "SS. Annunziata" Hospital, "G. D'Annunzio" University, Via De' Vestini, 66100, Chieti, Italy. 3. Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. 4. Intensive Cardiac Care Unit, "SS. Annunziata" Hospital, Chieti, Italy. 5. Arrhythmology Unit, "SS. Annunziata" Hospital, Chieti, Italy.
Abstract
BACKGROUND AND PURPOSE:High-dose 6‑MV radiotherapy may cause cardiac implantable electronic devices (CIEDs) to malfunction. To assess CIED malfunctions resulting from direct exposure up to 10 Gy, 100 pacemakers (PMs) and 40 implantable cardioverter-defibrillators (ICDs) were evaluated. MATERIALS AND METHODS: CIEDs underwent baseline interrogation. In ICDs, antitachycardia therapies were disabled via the programmer while the detection windows were left enabled. A computed tomography (CT) scan was performed to build the corresponding treatment plan. CIEDs were "blinded" and randomized to receive single doses of either 2, 5, or, 10 Gy via a 6-MV linear accelerator (linac) in a water phantom. Twenty-two wireless telemetry-enabled CIEDs underwent a real-time session, and their function was recorded by the video camera in the bunker. The CIEDs were interrogated after exposure and once monthly for 6 months. RESULTS: During exposure, regardless of dose, 90.9% of the CIEDs recorded electromagnetic interference, with 6 ICDs (27.3%) reporting pacing inhibition and inappropriate arrhythmia detections. After exposure, a backup reset was observed in 1 PM (0.7% overall, 1% among PMs), while 7 PMs (5% overall, 7% among PMs) reported battery issues (overall immediate malfunction rate was 5.7%). During follow-up, 4 PMs (2.9% overall; 4% among PMs) and 1 ICD (0.7% overall; 2.5% among ICDs) reported abnormal battery depletion, and 1 PM (0.7% overall; 1% among PMs) reported a backup reset (overall late malfunction rate was 4.3%). CONCLUSION: Apart from transient electromagnetic interference, last-generation CIEDs withstood direct 6‑MV exposure up to 10 Gy. Permanent battery or software errors occurred immediately or later only in less recent CIEDs.
RCT Entities:
BACKGROUND AND PURPOSE: High-dose 6‑MV radiotherapy may cause cardiac implantable electronic devices (CIEDs) to malfunction. To assess CIED malfunctions resulting from direct exposure up to 10 Gy, 100 pacemakers (PMs) and 40 implantable cardioverter-defibrillators (ICDs) were evaluated. MATERIALS AND METHODS: CIEDs underwent baseline interrogation. In ICDs, antitachycardia therapies were disabled via the programmer while the detection windows were left enabled. A computed tomography (CT) scan was performed to build the corresponding treatment plan. CIEDs were "blinded" and randomized to receive single doses of either 2, 5, or, 10 Gy via a 6-MV linear accelerator (linac) in a water phantom. Twenty-two wireless telemetry-enabled CIEDs underwent a real-time session, and their function was recorded by the video camera in the bunker. The CIEDs were interrogated after exposure and once monthly for 6 months. RESULTS: During exposure, regardless of dose, 90.9% of the CIEDs recorded electromagnetic interference, with 6 ICDs (27.3%) reporting pacing inhibition and inappropriate arrhythmia detections. After exposure, a backup reset was observed in 1 PM (0.7% overall, 1% among PMs), while 7 PMs (5% overall, 7% among PMs) reported battery issues (overall immediate malfunction rate was 5.7%). During follow-up, 4 PMs (2.9% overall; 4% among PMs) and 1 ICD (0.7% overall; 2.5% among ICDs) reported abnormal battery depletion, and 1 PM (0.7% overall; 1% among PMs) reported a backup reset (overall late malfunction rate was 4.3%). CONCLUSION: Apart from transient electromagnetic interference, last-generation CIEDs withstood direct 6‑MV exposure up to 10 Gy. Permanent battery or software errors occurred immediately or later only in less recent CIEDs.
Authors: Coen W Hurkmans; Egon Scheepers; Bob G F Springorum; Hans Uiterwaal Journal: Int J Radiat Oncol Biol Phys Date: 2005-09-01 Impact factor: 7.038
Authors: Tomas Zaremba; Annette Ross Jakobsen; Anna Margrethe Thøgersen; Lars Oddershede; Sam Riahi Journal: Europace Date: 2013-08-09 Impact factor: 5.214
Authors: Julia H Indik; J Rod Gimbel; Haruhiko Abe; Ricardo Alkmim-Teixeira; Ulrika Birgersdotter-Green; Geoffrey D Clarke; Timm-Michael L Dickfeld; Jerry W Froelich; Jonathan Grant; David L Hayes; Hein Heidbuchel; Salim F Idriss; Emanuel Kanal; Rachel Lampert; Christian E Machado; John M Mandrola; Saman Nazarian; Kristen K Patton; Marc A Rozner; Robert J Russo; Win-Kuang Shen; Jerold S Shinbane; Wee Siong Teo; William Uribe; Atul Verma; Bruce L Wilkoff; Pamela K Woodard Journal: Heart Rhythm Date: 2017-05-11 Impact factor: 6.343
Authors: J Wouter Jukema; Rohit J Timal; Joris I Rotmans; Liselotte C R Hensen; Maurits S Buiten; Mihaly K de Bie; Hein Putter; Aeilko H Zwinderman; Lieselot van Erven; M Jacqueline Krol-van Straaten; Nienke Hommes; Bas Gabreëls; Wim van Dorp; Bastiaan van Dam; Charles A Herzog; Martin J Schalij; Ton J Rabelink Journal: Circulation Date: 2019-03-18 Impact factor: 29.690
Authors: Ahmedin Jemal; Freddie Bray; Melissa M Center; Jacques Ferlay; Elizabeth Ward; David Forman Journal: CA Cancer J Clin Date: 2011-02-04 Impact factor: 508.702
Authors: Lars Køber; Jens J Thune; Jens C Nielsen; Jens Haarbo; Lars Videbæk; Eva Korup; Gunnar Jensen; Per Hildebrandt; Flemming H Steffensen; Niels E Bruun; Hans Eiskjær; Axel Brandes; Anna M Thøgersen; Finn Gustafsson; Kenneth Egstrup; Regitze Videbæk; Christian Hassager; Jesper H Svendsen; Dan E Høfsten; Christian Torp-Pedersen; Steen Pehrson Journal: N Engl J Med Date: 2016-08-27 Impact factor: 91.245