Key result
Radiation therapy is associated with low CIED dysfunction risk, with ~1% acute pacing threshold rises.
Why the study?
Real-world evidence on long-term CIED function post-RT is lacking, and current guidelines do not define optimal follow-up strategies.
Does radiation therapy cause acute or long-term device dysfunction in patients with cardiac implantable electronic devices?
Cohort (n=388)
No
Does radiation therapy cause acute or long-term device dysfunction in patients with cardiac implantable electronic devices?
Radiation therapy is associated with a very low risk of acute or long-term CIED dysfunction when adhering to current cardio-oncology guidelines.
High mortality in this observational pacing cohort warrants cautious interpretation; leaves open causal device effects and need for randomized confirmation.
Background The number of patients with cardiac implantable electronic devices (CIEDs) undergoing radiation therapy (RT) continues to rise. However, there is no real-world evidence on long-term outcomes post-RT, and current guidelines do not define optimal follow-up strategies. We aimed to evaluate long-term CIED function after RT. Methods We retrospectively analysed all patients with CIEDs treated with RT in a tertiary cardio-oncology centre. Device risk was estimated according to European Society of Cardiology cardio-oncology guidelines. Early follow-up included device interrogations before and after RT, while long-term follow-up incorporated outpatient records and structured patient contact. All-cause survival was obtained from administrative data. Results A total of 388 patients (408 RT courses; 29.0% pacing-dependent) were included. High-risk RT occurred in 36.8% of cases, with 1.7% exposed to beam energies >10 MV. Acute right atrial and right ventricular pacing threshold rises ≥1.0 V were observed in 1.2–1.3% of patients, and one transient device reset was noted. Over a median (Q1–Q3) follow-up of 1.81 (0.97–3.52) years, all-cause mortality was 45.1%, with no significant differences regarding pacing dependence or device type. Among 141 patients with detailed long-term follow-up, only minor, non-progressive threshold changes were observed, rarely exceeding 1.0 V. No premature battery depletion or RT-related lead extractions occurred. Conclusions RT was associated with a low risk of acute or long-term CIED dysfunction. Adherence to current cardio-oncology recommendations enables safe RT delivery in patients with CIEDs, even over long-term follow-up suggesting that the post-RT device management may be similar to that of patients not requiring RT.
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Dyrbus et al. (2026) conducted a cohort in Cardiac implantable electronic devices (CIEDs) undergoing radiation therapy (n=388). Radiation therapy was evaluated on Long-term CIED function after radiation therapy. Radiation therapy in patients with cardiac implantable electronic devices was associated with a low risk of device dysfunction, with acute pacing threshold rises occurring in only 1.2-1.3% of patients.
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