Incidence and Predictors of Cardiac Implantable Electronic Devices Malfunction with Radiotherapy Treatment

Figure 1. Pre-RT assessment form used in Bendigo Hospital. This form includes important information, such as details of CIED (device type, brand, mode, and site of implant) and RT (anatomical site of treatment, dose/fractions, dose to device, beam energy, and beam energy dose). This form concludes with a recommendation from the medical physicist, after evaluation of the CIED malfunction risk from the RT data.

Figure 2. Study flow diagram showing patient selection, exclusions, and distribution of patients. CIED, cardiac implantable electronic device; ICD-10, The International Classification Diagnosis of Disease 10th Version; RT, radiotherapy. Central illustration: Incidence and predictors of cardiac implantable electronic device malfunction (CIED) with radiotherapy (RT). There were 17 patients with CIED malfunction out of 441 patients who underwent RT. Patients with CIED malfunction had a higher median RT cumulative dose (42.5 Gy vs. 36 Gy) and beam energy dose (14 vs. 6.75 MV). Types of CIED malfunction ranges from minor electrical reset, noise oversense with no symptoms, change in lead parameters and unexpected decline in battery life. Adjusted logistic regression analysis identified that CIED from ICD device class, anatomical RT field above the diaphragm and usage of photon beam energy ≥ 10 MV were predictors of CIED malfunction with RT. There was no significant correlation between cumulative RT dose and CIED malfunction. A and P, abdomen and pelvis; CIED, cardiac implantable electronic device; H and N, head and neck; PPM, permanent pacemaker; Gy, Gray; ICD, implantable cardioverter…