Key result
Radiotherapy in patients with cardiac implantable electronic devices caused dysfunction in 14.1% of courses, with neutron-producing irradiation significantly increasing risk (OR 5.59; 95% CI 1.09-28.65).
Why the study?
Increasing numbers of patients with CIEDs undergo radiotherapy for cancer, but prospective data on the incidence, characteristics, and associated factors of related CIED dysfunctions were needed.
What is the incidence and what are the associated factors of cardiac implantable electronic device dysfunction in patients undergoing radiotherapy?
Cohort (n=92)
What is the incidence and what are the associated factors of cardiac implantable electronic device dysfunction in patients undergoing radiotherapy?
Odds Ratio: 5.59 (95% CI 1.09–28.65)
p-value: p=0.039
Radiotherapy causes subclinical CIED dysfunction in 14.1% of courses, with higher risk associated with neutron-producing irradiation and higher cumulative tumor doses, highlighting the need for careful monitoring.
Subclinical CIED dysfunction occurs in 14% of RT courses without clinical events; leaves open optimal monitoring for neutron-producing regimens.
BACKGROUND: Increasing numbers of patients with cardiac implantable electronic devices (CIEDs) are undergoing radiotherapy (RT) for cancer. The aim of the study was to prospectively evaluate the incidence, characteristics, and associated factors of CIED dysfunctions related to RT. METHODS: Between April 2013 and March 2020, all patients with a CIED who underwent ≥1 RT session were enrolled. Patients were monitored according to a systematic protocol, including device interrogation before the first and after each RT session. The primary endpoint was CIED dysfunction, defined as oversensing, total or partial deprogramming, and/or unrecoverable reset. RESULTS: We included a total of 92 CIED RT courses: 77 (83.7%) in patients with a pacemaker and 15 (16.3%) in those with an implantable cardioverter-defibrillator. Overall, 13 dysfunctions (14.1%) were observed during 92 courses (1509 sessions), giving an incidence of 0.9 per 100 sessions. These included nine deprogramming (three total resets to back-up pacing mode and six partial deprogramming that were all successfully reprogrammed), three transient oversensing, and one unrecoverable oversensing requiring CIED and leads replacement. There were no adverse clinical events related to device dysfunction. In multivariable analysis, neutron-producing irradiation (odds ratio [OR], 5.59; 95% confidence interval [CI], 1.09-28.65; p = .039) and cumulative tumor dose (OR, 1.05; 95% CI, 1.01-1.10; p = .007) remained significantly associated with CIED dysfunction. CONCLUSION: In this prospective study, transient or permanent subclinical CIED dysfunction occurred in 14.1% of RT courses. Our findings emphasize the importance of high-energy beams and neutron-producing irradiation in risk assessment.
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Frey et al. (2022) conducted a cohort in Cancer with cardiac implantable electronic devices undergoing radiotherapy (n=92). Radiotherapy (neutron-producing irradiation) was evaluated on CIED dysfunction (oversensing, total or partial deprogramming, and/or unrecoverable reset) (OR 5.59, 95% CI 1.09-28.65, p=0.039). Radiotherapy in patients with cardiac implantable electronic devices caused dysfunction in 14.1% of courses, with neutron-producing irradiation significantly increasing risk (OR 5.59; 95% CI 1.09-28.65).
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