Radiation therapy in patients with cardiac implantable electronic devices

BACKGROUND The number of patients with cardiac implantable electronic devices (CIEDs) treated with radiation therapy (RT) as an oncological treatment is expected to increase. AIMS The aim of the study was to assess whether cancer treatment with radiation therapy is associated with any device dysfunctions and device-related threats in patients with CIEDs. METHODS The risk of all patients with CIEDs undergoing RTwas assessed according to guidelines. Device interrogations were performed before the first and after the last RT session. In patients at high risk and/or with an implantable cardioverter-defibrillator or cardiac resynchronization therapy with defibrillator (CRT-D), all sessions were supervised by a cardiologist, and device interrogations were performed before and after every single RT session. Device parameters and events were monitored during the whole treatment. RESULTS The study included 157 patients with CIEDs who had palliative (n = 71) or radical (n = 86) RT. Pacemakers were implanted in 113 patients, implantable cardioverter-defibrillators in 36, and CRT-D in 8. During the 2396 RT sessions (median [interquartile range], 5 [5-28] per patient) with cumulative dose up to 78 Gy per patient for the whole RT treatment and maximum energy beam up to 20 MV, 2 events potentially related to radiation were recorded. CONCLUSIONS Radiation therapy in patients with CIEDs is not associated with substantial risk to the patients assuming the patients' management follows current guidelines.