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Strahlentherapie bei Patienten mit Herzschrittmachern oder implantierbaren Kardioverter-Defibrillatoren

Interdisziplinäre Sicherheitsempfehlungen

Radiation therapy in patients with cardiac pacemakers or implantable cardioverter defibrillators

Interdisciplinary safety recommendations

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Strahlentherapie und Onkologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Mit steigender Zahl implantierter Herzschrittmacher und implantierbarer Kardioverter-Defibrillatoren (ICD) und einer steigenden Inzidenz von onkologischen Erkrankungen nimmt die Wahrscheinlichkeit für strahlungsbedingte Gerätestörungen zu. Die veröffentlichten Leitlinien zum Management von Schrittmacherpatienten stammen aus dem Jahr 1994 und sind seitdem nicht mehr aktualisiert worden. Auf Basis der aktuellen Evidenz und moderner Gerätetechnologie möchte die vorliegende Arbeit ein zeitgemäßes, interdisziplinäres Sicherheitsprotokoll zur Minimierung des Patientenrisikos entwickeln.

Methoden und Ergebnisse

Es wurde eine systematische Literaturrecherche in den wichtigsten medizinischen elektronischen Datenbanken durchgeführt. Für den Publikationszeitraum von 1994 bis 2012 ergab die Suche 147 Treffer, von denen 45 in die Bewertung eingeschlossen wurden. Primärdaten wurden von 34 Studien erhoben (9 In-vitro- und 25 In-vivo-Studien). Der Störeinfluss ionisierender Strahlung auf implantierte Geräte schwankte zwischen keinerlei Funktionsänderungen und komplettem Funktionsverlust. Relevante Fehlfunktionen beinhalteten eine Veränderung der Wahrnehmung, der Stimulationsleistung, gestörte Tachyarrhythmie-Therapien (bei ICDs), eine vorzeitige Batterieerschöpfung sowie einen Verlust der Telemetrie. Moderne Herzschrittmacher und ICDs sind strahlenempfindlicher als ältere Modelle. Potentiell lebensbedrohliche Zwischenfälle wurden bereits nach Exposition des Aggregats gegenüber relativ niedrigen Dosen beobachtet (0,11 Gy).

Schlussfolgerung

Es werden konkrete Sicherheitsempfehlungen zum Patientenmanagement vorgestellt, die ohne Weiteres von Einrichtungen, die strahlentherapeutische Leistungen anbieten, übernommen werden können.

Abstract

Background

With increasing numbers of implanted pacemakers and implantable cardioverter defibrillators (ICD) and a rising incidence of malignant tumors, there is a growing probability of radiation-mediated device dysfunction. The only guidelines for the management of patients with cardiac pacemakers in the case of radiation therapy were published in 1994 and have not been updated since then. Based on the current evidence and modern device technology, the present paper aims to develop contemporary and interdisciplinary safety recommendations for the minimization of patient risk.

Methods and results

A systematic literature research was carried out including the most relevant medical electronic databases. The search yielded 147 articles published between 1994 and 2012 of which 45 met the selection criteria and of these studies 34 presented primary data (9 in vitro and 25 in vivo studies). The impact of ionizing radiation varied significantly between implanted devices and ranged from no functional changes to complete loss of function. Important device dysfunctions included changes in sensing capability, altered pacing pulses or rate, changed or disabled tachyarrhythmia ICD therapies, early battery depletion and loss of telemetry. Modern pacemakers and ICDs are more sensitive to radiation than older models. Potentially life-threatening complications were observed after exposure of the pulse generator to comparatively low radiation doses (0.11 Gy).

Conclusions

Practical recommendations for patient management and safety are presented that can be readily adopted by any institution carrying out radiation therapy.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Interessenkonflikte hin: W. Haverkamp hat Vortrags- und/oder Beraterhonorare von den Firmen Biotronik, Medtronic und St. Jude Medical erhalten. M. Roser hat Vortragshonorare von den Firmen Biotronik, Boston Scientific, Medtronic und St. Jude Medical erhalten. Die übrigen Autoren geben keine Interessenkonflikte an.

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Authors and Affiliations

  1. Medizinische Klinik mit Schwerpunkt Kardiologie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    M. Dorenkamp, W. Haverkamp &  M. Roser

  2. Klinik für Radioonkologie und Strahlentherapie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    C. Stromberger & P. Wust

  3. Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland

    C. von Heymann

Authors
  1. M. Dorenkamp
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  2. C. Stromberger
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  3. C. von Heymann
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  4. W. Haverkamp
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  5. P. Wust
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  6. M. Roser
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Correspondence to M. Roser.

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Dorenkamp, M., Stromberger, C., von Heymann, C. et al. Strahlentherapie bei Patienten mit Herzschrittmachern oder implantierbaren Kardioverter-Defibrillatoren. Strahlenther Onkol 189, 5–17 (2013). https://doi.org/10.1007/s00066-012-0243-8

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