title: [Radiation therapy in patients with cardiac pacemakers or implantable cardioverter defibrillators. Interdisciplinary safety recommendations].
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.
  
  
  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.
authors.affiliation: Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Dorenkamp
authors.forename: C
authors.initials: C
authors.lastname: Stromberger
authors.forename: C
authors.initials: C
authors.lastname: von Heymann
authors.forename: W
authors.initials: W
authors.lastname: Haverkamp
authors.forename: P
authors.initials: P
authors.lastname: Wust
authors.forename: M
authors.initials: M
authors.lastname: Roser
mesh_terms: D058406:Cardiac Resynchronization Therapy; D000075202:Contraindications; D003299:Cooperative Behavior; D017147:Defibrillators, Implantable; D004307:Dose-Response Relationship, Radiation; D019544:Equipment Failure Analysis; D019317:Evidence-Based Medicine; D006801:Humans; D033183:Interdisciplinary Communication; D010138:Pacemaker, Artificial; D061214:Patient Safety; D011474:Prosthesis Design; D011878:Radiotherapy; D013686:Telemetry; D013899:Thoracic Neoplasms / Q000532:radiotherapy*