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Radiotherapy-induced malfunctions of cardiac implantable electronic devices in cancer patients

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Abstract

The number of patients with cardiac implantable electronic devices (CIEDs) requiring radiation therapy (RT) for cancer treatment is increasing. The purpose of this study is to estimate the prevalence, possible predictors, and clinical impact of RT-related CIEDs malfunctions. We retrospectively reviewed the medical records of all pacemaker (PM)/implantable cardioverter-defibrillator (ICD) patients who underwent RT in the last 14 years. One hundred and twenty-seven patients who underwent 150 separate RT courses were analysed (99 with a PM and 27 with an ICD). Of note, 21/127 (16.6%) patients were PM-dependent. Neutron-producing RT was used in 37/139 (26.6%) courses, whereas non-neutron-producing RT was used in 102/139 (73.4%) courses. The cumulative dose (Dmax) delivered to the CIED exceeded 5 Gy only in 2/132 (1.5%) cases. Device malfunctions were observed in 3/150 (2%) RT courses, but none was life-threatening or led to a major clinical event and all were resolved by CIED reprogramming. In all cases, the Dmax delivered to the CIED was < 2 Gy. Two malfunctions occurred in the 37 patients treated with neutron-producing RT (5.4%), and 1 malfunction occurred in the 102 patients treated with non-neutron-producing RT (1%) (p = 0.17). Device relocation from the RT field was performed in 2/127 (1.6%) patients. RT in patients with CIED is substantially safe if performed in an appropriately organized environment, with uncommon CIEDs malfunctions and no major clinical events. Neutron-producing energies, rather than Dmax, seem to increase the risk of malfunctions. Device interrogation on a regular basis is advised to promptly manage CIED malfunctions.

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Authors and Affiliations

  1. Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy

    Vincenzo L. Malavasi, Jacopo F. Imberti, Filippo Placentino, Marco Vitolo, Edoardo Casali, Vincenzo Turco & Giuseppe Boriani

  2. Radiotherapy Division, Department of Oncology, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy

    Giuseppina De Marco, Ercole Mazzeo & Frank Lohr

  3. Department of Medical Physics, Policlinico Di Modena, Modena, Italy

    Gianfranco Cicoria

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  1. Vincenzo L. Malavasi
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Correspondence to Giuseppe Boriani.

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Conflict of interest

Professor Boriani has received small speaker’s fees from Medtronic, Boston, Boehringer, and Bayer, outside of the submitted work. The other authors reported no conflict of interest.

Human and animal rights statement

Protocol approved by the Ethical Committee (No. 750/2018/OSS/AOUMO). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Due to retrospective design of the study, no informed consent needed.

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Malavasi, V.L., De Marco, G., Imberti, J.F. et al. Radiotherapy-induced malfunctions of cardiac implantable electronic devices in cancer patients. Intern Emerg Med 15, 967–973 (2020). https://doi.org/10.1007/s11739-019-02240-y

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