• Michela Brambatti, Rebecca Mathew, Barbara Strang, Joan Dean, Anuja Goyal, Joseph E Hayward, Laurene Long, Patty DeMeis, Marcia Smoke, Stuart J Connolly, Carlos A Morillo, Guy Amit, Alessandro Capucci, and Jeff S Healey.
• 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.
• Heart Rhythm. 2015 Oct 1; 12 (10): 2148-54.

BackgroundRadiation 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.ObjectiveThe 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.MethodsIn 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.ResultsOf 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.ConclusionNearly 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.Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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