A randomized in vitro evaluation of transient and permanent cardiac implantable electronic device malfunctions following direct exposure up to 10 Gy

Falco, M.D.; Genovesi, Domenico; Caravatta, L.; Carlo, C. Di; Bliakharskaia, Ekaterina; Appignani, Marianna; Faustino, Massimiliano; Furia, N.; Girolamo, Enrico Di

doi:10.1007/s00066-020-01651-7

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…In addition, a direct effect of radiation on CIED hardware integrity is a possibility. 10 The combination of any or all of these effects will result in the clinically observed impact on CIED parameters following irradiation. In this patient it is not possible to draw definitive conclusions regarding the mechanism of the observed increase in stimulation threshold; however, the time-course suggests an effect prior to when myocardial fibrosis occurs.…”

Section: Discussionmentioning

confidence: 99%

Increase in right ventricular lead pacing threshold following stereotactic ablative therapy for ventricular tachycardia

Wijesuriya¹,

Galante²,

Sisodia³

et al. 2023

HeartRhythm Case Reports

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Section: Discussionmentioning

confidence: 99%

Increase in right ventricular lead pacing threshold following stereotactic ablative therapy for ventricular tachycardia

Wijesuriya¹,

Galante²,

Sisodia³

et al. 2023

HeartRhythm Case Reports

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“…First, the failure criterion was met at a cumulative dose of 10 Gy, and the battery impedance increased about 1.8 times the initial value, indicating battery depletion ( Figure 2 ). In a previous study with WFF beams at a cumulative dose of 10 Gy, an ICP that had sufficient battery capacity before the start of the experiment had an unexpected battery drainage [ 22 ]. In our study, battery depletion might have occurred by setting the pacing-output as high, giving priority to the observation of the pacing-output voltage with an oscilloscope.…”

Section: Discussionmentioning

confidence: 99%

Implantable cardiac pacemaker failure by cumulative dose effects of flattening filter free beams

Nakamura

Aoyama

Kaneda

et al. 2021

Journal of Radiation Research

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Cumulative dose effects, which are one of the main causes of errors that occur when an implantable cardiac pacemaker (ICP) is irradiated with ionizing radiation, induce permanent failure in ICPs. Although flattening filter free (FFF) beams, which are often used in stereotactic radiotherapy, are known to have different characteristics from conventional (with flattening filter [WFF]) beams, the cumulative dose effects on ICPs with FFF beams have been under-investigated. This study investigates ICP failure induced by cumulative dose effects of FFF beams. When the ICP placed in the center of the irradiation field was irradiated with 10 MV-FFF at 24 Gy/min, the cumulative dose at which failure occurred was evaluated on the basis of the failure criteria associated with high cumulative dose as described in the American Association of Physicists in Medicine Task Group 203. The ICP failures such as a mild battery depletion at a cumulative dose of 10 Gy, pacing-output voltage change >25% at a cumulative dose of 122 Gy, and the loss of telemetry capability at cumulative dose 134 Gy were induced by cumulative dose effects. The cumulative doses by which the cumulative dose effects of FFF beams induced ICP failure were not very different from those reported in previous studies with WFF beams. Therefore, radiotherapy with FFF beams (and WFF beams) for patients with ICP requires appropriate management for minimizing the cumulative dose effects.

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“…These malfunctions appear to be related to device cumulative radiation dose, and interactions of secondary neutrons with the device particularly at photon energies ≥10 MV and electron energies of ≥ 20MeV. However, CIED malfunctions as a result of electromagnetic interference (EMI) have also been previously reported during photon-EBRT ( 13 ). The influence of EMI generated by linear accelerators vary in different modalities ( 14 – 16 ).…”

Section: Introductionmentioning

confidence: 99%

“…For instance, in the passive scattering (PS) mode, a larger number of neutrons are inevitably scattered both inside the treatment room and within the patient body (due to a greater number of beam modifiers) increasing the risk of secondary malignancies ( 48 , 49 ). In the pencil beam scanning (PBS) mode, neutron production is substantially reduced outside the patient’s body, yet a considerable number of neutrons are still generated within the patient body ( 13 , 50 ).…”

Section: Introductionmentioning

confidence: 99%

Risk of cardiac implantable device malfunction in cancer patients receiving proton therapy: an overview

et al. 2023

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Age is a risk factor for both cardiovascular disease and cancer, and as such radiation oncologists frequently see a number of patients with cardiac implantable electronic devices (CIEDs) receiving proton therapy (PT). CIED malfunctions induced by PT are nonnegligible and can occur in both passive scattering and pencil beam scanning modes. In the absence of an evidence-based protocol, the authors emphasise that this patient cohort should be managed differently to electron- and photon- external beam radiation therapy (EBRT) patients due to distinct properties of proton beams. Given the lack of a PT-specific guideline for managing this cohort and limited studies on this important topic; the process was initiated by evaluating all PT-related CIED malfunctions to provide a baseline for future reporting and research. In this review, different modes of PT and their interactions with a variety of CIEDs and pacing leads are discussed. Effects of PT on CIEDs were classified into a variety of hardware and software malfunctions. Apart from secondary neutrons, cumulative radiation dose, dose rate, CIED model/manufacturer, distance from CIED to proton field, and materials used in CIEDs/pacing leads were all evaluated to determine the probability of malfunctions. The importance of proton beam arrangements is highlighted in this study. Manufacturers should specify recommended dose limits for patients undergoing PT. The establishment of an international multidisciplinary team dedicated to CIED-bearing patients receiving PT may be beneficial.

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A randomized in vitro evaluation of transient and permanent cardiac implantable electronic device malfunctions following direct exposure up to 10 Gy

Cited by 7 publications

References 30 publications

Increase in right ventricular lead pacing threshold following stereotactic ablative therapy for ventricular tachycardia

Increase in right ventricular lead pacing threshold following stereotactic ablative therapy for ventricular tachycardia

Implantable cardiac pacemaker failure by cumulative dose effects of flattening filter free beams

Risk of cardiac implantable device malfunction in cancer patients receiving proton therapy: an overview

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A randomized in vitro evaluation of transient and permanent cardiac implantable electronic device malfunctions following direct exposure up to 10 Gy

Cited by 7 publications

References 30 publications

Increase in right ventricular lead pacing threshold following stereotactic ablative therapy for ventricular tachycardia

Increase in right ventricular lead pacing threshold following stereotactic ablative therapy for ventricular tachycardia

Implantable cardiac pacemaker failure by cumulative dose effects of flattening filter free beams

Risk of cardiac implantable device malfunction in cancer patients receiving proton therapy: an overview

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A randomized in vitro evaluation of transient and permanent cardiac implantable electronic device malfunctions following direct exposure up to 10 Gy