Risk-Based Management of Patients with Cardiac Implantable Electronic Devices Underwent Radiation Therapy: A Practical Review

Q: What is the clinical evidence from this study?

Study design: Review. Population: Cardiac Implantable Electronic Devices (CIED) undergoing Radiation Therapy. Intervention: Radiation therapy (including photon, proton, electron, and carbon-ion beams). Primary outcome: Incidence and clinical pattern of CIED malfunction.

Q: What does this research mean for the field?

Risk-based management strategies provide practical guidance for ensuring the safety of patients with cardiac implantable electronic devices undergoing radiation therapy. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Na Hye Kwon; Inbum Lee; Euntaek Yoon; Bo‐Wi Cheon; Young Jae Jang; Chang Heon Choi; Hyeongmin Jin; Jaeman Son; Jong Min Park; Jung‐in Kim; Seonghee Kang; Sung Hyun Lee; Yoonsuk Huh

doi:10.14316/pmp.2026.37.3.89

September 22, 2026Progress in Medical PhysicsOpen Access

Risk-Based Management of Patients with Cardiac Implantable Electronic Devices Underwent Radiation Therapy: A Practical Review

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Key result

Radiation therapy carries low overall CIED malfunction risk, but high-energy beams increase electrical resets.

Why the study?

What is the risk of CIED malfunction during radiation therapy and how can it be managed?

Key Points

To review clinical evidence and risk-adapted strategies for managing patients with cardiac implantable electronic devices undergoing radiotherapy.
Synthesized findings from clinical cohorts, guideline implementation analyses, and phantom evaluations of pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy devices.
Assessed device performance across external beam radiotherapy modalities—including 3D-CRT, IMRT, VMAT, SBRT, proton, and carbon-ion therapy—and photon energies ranging from 6 MV to 18 MV.
Clinical device malfunction incidences ranged from 1.04% (2/193 pts) and 1.1% (8/752 courses) to 14.1% (13/92 courses), presenting mainly as software resets, backup-mode changes, or data loss.
High-energy neutron-producing photon beams (>10 MV) and particle therapies were key predictors of device resets, accounting for 4/5 events in one cohort.
Implementing structured guideline protocols and restricting photon energy to 6 MV decreased malfunction rates from 7/40 events under TG-203 to 1/160 under DEGRO/DGK protocols.

Structured PICO

What is the risk of CIED malfunction during radiation therapy and how can it be managed?

P

Population

A practical review of multiple retrospective cohorts, prospective studies, and case reports evaluating the incidence, mechanisms, and management of CIED malfunctions during radiation therapy.

E

Exposure

Radiation therapy (including photon, proton, electron, and carbon-ion beams) with risk-based device monitoring and management

O

Outcome

Incidence and clinical pattern of CIED malfunctionsafety

Limitations

Evidence is largely based on retrospective cohorts, single-institution analyses, and case reports
Heterogeneity in radiation modalities, beam energies, and CIED monitoring protocols across included studies

Implication

Risk-based management, including appropriate beam energy selection and structured monitoring, enables safe delivery of radiotherapy in patients with CIEDs.

Abstract

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Discussion

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Cite This Study

Kwon et al. (2026) conducted a review in Cardiac Implantable Electronic Devices (CIED) undergoing Radiation Therapy. Radiation therapy (including photon, proton, electron, and carbon-ion beams) was evaluated on Incidence and clinical pattern of CIED malfunction. Radiation therapy in patients with cardiac implantable electronic devices is associated with a generally low rate of device malfunction, though the risk of electrical resets and other events increases with the use of neutron-producing or high-energy photon beams.

synapsesocial.com/papers/6ab614b5406bf401c146a382 https://doi.org/10.14316/pmp.2026.37.3.89

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Risk-Based Management of Patients with Cardiac Implantable Electronic Devices Underwent Radiation Therapy: A Practical Review

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Risk-Based Management of Patients with Cardiac Implantable Electronic Devices Underwent Radiation Therapy: A Practical Review

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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