A systematic review and meta‐analysis on oncological radiotherapy in patients with a cardiac implantable electronic device: Prevalence and predictors of device malfunction in 3121 patients

Abstract

Background The number of patients with cardiac implantable electronic devices (CIEDs) undergoing radiotherapy (RT) for cancer treatment is growing. At present, prevalence and predictors of RT‐induced CIEDs malfunctions are not defined. Methods Systematic review and meta‐analysis conducted following the PRISMA recommendations. PubMed, Scopus and Google Scholar were searched from inception to 31/01/2022 for studies reporting RT‐induced malfunctions in CIEDs patients. Aim was to assess the prevalence of RT‐induced CIEDs malfunctions and identify potential predictors. Results Thirty‐two out of 3962 records matched the inclusion criteria and were included in the meta‐analysis. A total of 135 CIEDs malfunctions were detected among 3121 patients (6.6%, 95% confidence interval [CI]: 5.1%–8.4%). The pooled prevalence increased moving from pacemaker (PM) to implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy and defibrillator (CRT‐D) groups (4.1%, 95% CI: 2.9–5.8; 8.2% 95% CI: 5.9–11.3; and 19.8%, 95% CI: 11.4–32.2 respectively). A higher risk ratio (RR) of malfunctions was found when neutron‐producing energies were used as compared to non‐neutron‐producing energies (RR 9.98, 95% CI: 5.09–19.60) and in patients with ICD/CRT‐D as compared to patients with PM/CRT‐P (RR 2.07, 95% CI: 1.40–3.06). On the contrary, no association was found between maximal radiation dose at CIED >2 Gy and CIEDs malfunctions (RR 0.93; 95% CI: 0.31–2.76). Conclusions Radiotherapy related CIEDs malfunction had a prevalence ranging from 4% to 20%. The use of neutron‐producing energies and more complex devices (ICD/CRT‐D) were associated with higher risk of device malfunction, while the radiation dose at CIED did not significantly impact on the risk unless higher doses (>10 Gy) were used.

Impact of Radiotherapy on Malfunctions and Battery Life of Cardiac Implantable Electronic Devices in Cancer Patients

“…In concordance with the only meta-analysis on CIED malfunctions, we observed relatively more malfunctions in ICDs (4/68) and CRT devices (3/16) than in PMs (2/171) [29]. Furthermore, a significant correlation between malfunction in CIEDs and maximum photon energy was almost reached in our cohort (p = 0.07), suggesting that neutron-producing energies might increase the risk of malfunction, as suggested in previous publications [29,30].…”

Cardiac Interventions in Patients With Active, Advanced Solid and Hematologic Malignancies

“… 55 A systematic review identified a pooled incidence of device malfunction of 6.6% (95% CI: 5.1%-8.4%) in 3121 patients. 56 The RR of device malfunction was higher when neutron-producing energies were delivered (pooled RR: 9.98; 95% CI: 5.09-19.60) and for ICDs/CRT defibrillators compared with pacemakers or CRT pacemakers (pooled RR: 2.07; 95% CI: 1.40-3.06). Also, thrombocytopenia and neutropenia caused by cancer therapy may increase the risk of bleeding and infection, respectively.…”

Cardiac pacing and lead devices management: 25 years of research at EP Europace journal

“…Over the years, 2–7% of patients with CIEDS undergoing therapeutic radiation developed some kind of device malfunction. 101 , 103 , 104 The risk of malfunction is related to the location and cumulative dose of irradiation, mainly at the generator site, type of energy (proton beam more dangerous), and modes of shielding. 105 Until recently, there was wide variation in the approach to patients with CIEDS undergoing radiation therapy 106 and the EHRA document meant to set more uniform standards.…”