title: Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review.
abstract: An increasing number of patients with implantable cardiac rhythm devices undergo radiotherapy (RT) for cancer and are thereby exposed to the risk of device failure. Current safety recommendations seem to have limitations by not accounting for the risk of pacemakers and implantable cardioverter defibrillators malfunctioning at low radiation doses. Besides scant knowledge about optimal safety measures, only little is known about the exact prevalence of patients with devices undergoing RT. In this review, we provide a short overview of the principles of RT and present the current evidence on the predictors and mechanisms of device malfunctions during RT. We also summarize practical recommendations from recent publications and from the industry. Strongly associated with beam energy of photon RT, device malfunctions occur at ∼3% of RT courses, posing a substantial issue in clinical practice. Malfunctions described in the literature typically consist of transient software disturbances and only seldom manifest as a permanent damage of the device. Through close cooperation between cardiologists and oncologists, a tailored individualized approach might be necessary in this patient group in waiting time for updated international guidelines in the field.
authors.affiliation: Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark tz@rn.dk.
authors.forename: Tomas
authors.initials: T
authors.lastname: Zaremba
authors.affiliation: Department of Medical Physics, Oncology Department, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark.
authors.forename: Annette Ross
authors.initials: AR
authors.lastname: Jakobsen
authors.affiliation: Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Søgaard
authors.affiliation: Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark.
authors.forename: Anna Margrethe
authors.initials: AM
authors.lastname: Thøgersen
authors.affiliation: Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Sdr. Skovvej 15, Aalborg 9000, Denmark.
authors.forename: Sam
authors.initials: S
authors.lastname: Riahi
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000592:standards; D017147:Defibrillators, Implantable / Q000592:standards; D004554:Electric Countershock / Q000295:instrumentation* / Q000592:standards; D004869:Equipment Safety; D006801:Humans; D010138:Pacemaker, Artificial / Q000592:standards; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011878:Radiotherapy / Q000009:adverse effects* / Q000592:standards; D011879:Radiotherapy Dosage; D018570:Risk Assessment; D012307:Risk Factors
keywords: Device malfunction; Epidemiology; Implantable cardioverter defibrillator; Pacemaker; Radiotherapy; Safety