Radiotherapy-Induced Cardiac Implantable Electronic Device Dysfunction in Patients With Cancer.
Radiotherapy can affect the electronic components of a cardiac implantable electronic device (CIED) resulting in malfunction and/or damage. We sought to assess the incidence, predictors, and clinical impact of CIED dysfunction (CIED-D) after radiotherapy for cancer treatment. Clinical characteristics, cancer, different types of CIEDs, and radiation dose were evaluated. The investigation identified 230 patients, mean age 78 ± 8 years and 70% were men. A total of 199 patients had pacemakers (59% dual chamber), 21 (9%) cardioverter-defibrillators, and 10 (4%) resynchronizators or defibrillators. The left pectoral (n = 192, 83%) was the most common CIED location. Sixteen patients (7%) experienced 18 events of CIED-D after radiotherapy. Reset to backup pacing mode was the most common encountered dysfunction, and only 1 (6%) patient of those with CIED-D experienced symptoms of atrioventricular dyssynchrony. Those who had CIED-D tended to have a shorter device age at the time of radiotherapy compared to those who did not (2.5 ± 1.5 vs 3.8 ± 3.4 years, p = 0.09). The total dose prescribed to the tumor was significantly greater among those who had CIED-D (66 ± 30 vs 42 ± 23 Gy, p <0.0001). Multivariate logistic regression analysis identified the total dose prescribed to the tumor as the only independent predictor for CIED-D (odds ratio 1.19 for each increase in 5 Gy, 95% confidence interval 1.08 to 1.31, p = 0.0005). In conclusion, in this large population of patients with CIEDs undergoing radiotherapy for cancer treatment, the occurrence of newly diagnosed CIED-D was 7%, and the reset to backup pacing mode was the most common encountered dysfunction. The total dose prescribed to the tumor was a predictor of CIED-D. Importantly, although the unpredictability of CIEDs under radiotherapy is still an issue, none of our patients experienced significant symptoms, life-threatening arrhythmias, or conduction disorders.
Cardiology Division, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. Electronic address: rodrigobagur@yahoo.com.
Rodrigo
R
Bagur
Cardiology Division, Department of Medicine, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada.
Mathilde
M
Chamula
Department of Radio-Oncology, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada.
Émilie
É
Brouillard
Department of Radio-Oncology, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada.
Caroline
C
Lavoie
Cardiology Division, Hospital Clínico San Carlos, Madrid, Spain.
Luis
L
Nombela-Franco
Clinical Research Platform, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada.
Anne-Sophie
AS
Julien
Department of Radio-Oncology, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada; Department of Physics, Engineering and Optics, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada.
Louis
L
Archambault
Department of Radio-Oncology, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada; Department of Physics, Engineering and Optics, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada.
Nicolas
N
Varfalvy
Cardiology Division, Department of Medicine, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada.
Valérie
V
Gaudreault
Cardiology Division, Department of Medicine, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada.
Sébastien X
SX
Joncas
Cardiology Division, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada.
Zeev
Z
Israeli
Cardiology Division, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada.
Yasir
Y
Parviz
Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care, Keele University, Stoke-on-Trent, United Kingdom.
Mamas A
MA
Mamas
Cardiology Division, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada.
Shahar
S
Lavi
D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000532:radiotherapy*; D010138:Pacemaker, Artificial; D011878:Radiotherapy / Q000009:adverse effects*; D012307:Risk Factors