title: Management of patients with implantable cardioverter-defibrillators and pacemakers who require radiation therapy.
abstract: BACKGROUND
  Radiation therapy (RT) may pose acute and long-term risks for patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). However, the frequency of these problems has not been accurately defined.
  
  
  OBJECTIVE
  The purpose of this study was to determine the prevalence of CIEDs among patients requiring RT and report the common CIED-related problems when patients are managed according to a standard clinical care path.
  
  
  METHODS
  In a single tertiary-care center, we prospectively screened all patients requiring RT and identified patients with ICDs or PMs. We collected clinical data about their cancer, RT treatment plan, and CIED. Radiation dose to the device was estimated in all patients, and any device malfunction during RT was documented.
  
  
  RESULTS
  Of the 34,706 consecutive patients receiving RT, 261 patients (0.8%, mean age 77.9 ± 9.4 years) had an implantable cardiac device: 54 (20.7%) ICDs and 207 (79.3%) PMs. The site of RT was head and neck (27.4%), chest (30.0%), and abdomen/pelvis (32.6%). Using our care path, 63.2% of patients required continuous cardiac monitoring, 14.6% required device reprogramming, 18.8% required magnet application during RT, and 3.4% required device repositioning to the contralateral side before RT. Four patients (1.5%) had inappropriate device function during RT: 3 experienced hemodynamically tolerated ventricular pacing at the maximum sensor rate, and 1 experienced a device power-on-reset. No patient died or suffered permanent device failure.
  
  
  CONCLUSIONS
  Nearly 1% of patients receiving RT in this series has a PM or ICD. However, with a systematic policy of risk assessment and patient management, significant device-related complications are rare.
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, Ancona, Italy. Electronic address: michelabrambatti@gmail.com.
authors.forename: Michela
authors.initials: M
authors.lastname: Brambatti
authors.affiliation: Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Mathew
authors.affiliation: Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Strang
authors.affiliation: Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Dean
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Anuja
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Hayward
authors.affiliation: Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Laurene
authors.initials: L
authors.lastname: Long
authors.affiliation: Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Patty
authors.initials: P
authors.lastname: DeMeis
authors.affiliation: Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Marcia
authors.initials: M
authors.lastname: Smoke
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Connolly
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Morillo
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Guy
authors.initials: G
authors.lastname: Amit
authors.affiliation: Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Healey
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D017147:Defibrillators, Implantable; D019468:Disease Management; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000532:radiotherapy*; D010138:Pacemaker, Artificial; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
keywords: Care path; Implantable cardioverter-defibrillator; Malfunction; Pacemaker; Radiation therapy