Patients with cardiac implantable electronic devices undergoing radiation therapy for cancer or magnetic resonance imaging

The number of patients with cardiac implantable electronic devices (CIEDs) continues to increase, paralleling a growing population of cancer patients requiring radiotherapy (RT) or magnetic resonance imaging (MRI). At the same time, major advances in CIED technology, RT techniques, and MRI safety protocols have created the need to revise and expand the recommendations presented in the 2019 Polish expert consensus. This document discusses various CIEDs in the context of the risks associated with RT and MRI, including devices not addressed in previous documents, such as leadless pacemakers, non-transvenous ICDs, conduction system pacing, and implantable loop recorders. The document outlines principles of risk stratification in patients with CIEDs before RT initiation and proposes management strategies during and after RT according to the assessed risk level. It also discusses the risks associated with MRI in patients with CIEDs, depending on the device type, system category (MRI-conditional vs. non-MRI-conditional), and the presence of abandoned, fractured, or epicardial leads. In addition, the document proposes an algorithm for MRI eligibility assessment and workflow. The document addresses multidisciplinary collaboration and organizational requirements, including the roles of cardiologists, radiation oncologists, radiologists, and MRI technicians. It recommends algorithms for device programming pathways and discusses principles for ensuring patient safety during radiotherapy or MRI scanning. The document also proposes practical checklists and templates covering pre-RT assessment, on-treatment management, post-RT follow-up, as well as pre- and post-MRI evaluation. This document provides updated, comprehensive, and practical recommendations for the management of patients with CIEDs undergoing radiotherapy or referred for magnetic resonance imaging.