Irradiation of Pacemakers and Cardio-Defibrillators in Patients Submitted to Radiotherapy: A Clinical Experience

Ferrara, Teresa; Baiotto, Barbara; Malinverni, Giuseppe; Caria, N.; Garibaldi, E.; Barboni, G; Stasi, M.; Gabriele, P.

doi:10.1177/030089161009600113

Cited by 34 publications

(27 citation statements)

References 30 publications

(63 reference statements)

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“…Ferrara et al reported no problems in a cohort of 45 patients with an average maximum CIED dose equal to 2.5 Gy for patients treated in the head & neck area and equal to 1.8 Gy for patients treated in the thoracic area [36]. Kapa et al reported on 12 patients treated between 2002 and 2007 [31].…”

Section: Methodsmentioning

confidence: 99%

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

et al. 2012

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Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient’s perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients’ perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well.

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Section: Methodsmentioning

confidence: 99%

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

et al. 2012

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“…There can be complex interplay between the dose‐rate, the frequency of dose pulses, and the sensing band of a CIED. It is not known which time‐scale is most relevant for dose‐rate effects: dose per linear accelerator (LINAC) pulse (elevated in flattening filter free “FFF” beams), dose per second (elevated for higher nominal dose‐rates), dose per minute (elevated in volumetric modulated radiation therapy “VMAT”), or dose per fraction (elevated in stereotactic body radiation therapy “SBRT” or stereotactic radiosurgery “SRS”) …”

Section: Conditions In Clinical Use That Can Induce Malfunctionsmentioning

confidence: 99%

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

et al. 2019

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Managing radiotherapy patients with implanted cardiac devices (implantable cardiac pacemakers and implantable cardioverter‐defibrillators) has been a great practical and procedural challenge in radiation oncology practice. Since the publication of the AAPM TG‐34 in 1994, large bodies of literature and case reports have been published about different kinds of radiation effects on modern technology implantable cardiac devices and patient management before, during, and after radiotherapy. This task group report provides the framework that analyzes the potential failure modes of these devices and lays out the methodology for patient management in a comprehensive and concise way, in every step of the entire radiotherapy process.

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“…Cardiac devices may be affected in two ways; electromagnetic interference (EMI) and direct damage to the circuitry via ionising radiation, both of which may cause temporary and permanent device malfunction [3]. Changes within the device parameters as result of EMI are seen even when the CIED is placed outside the radiotherapy treatment field [7].…”

Section: Introductionmentioning

confidence: 99%

A National Audit of Current Cardiac Device Policies from Radiotherapy Centres across the UK

et al. 2014

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Aims: The number of patients with cardiac implantable electronic devices (permanent pacemakers and implantable cardioverter defibrillators) undergoing radiotherapy treatment is increasing. The aims of this audit were to establish current UK practice regarding the management of patients with implanted cardiac devices undergoing radiotherapy and to compare this practice with current 'gold standard' evidence-based guidelines. Materials and methods: All UK radiotherapy departments were contacted and asked to provide their current cardiac implantable electronic device policy or to indicate if there was no current policy. A proforma was created to analyse these polices and to compare with current best practice. Results: In total, 47/67 (70%) radiotherapy departments responded and 45 departmental policies were submitted; 31/45 (69%) policies defined the radiotherapy tolerance dose to permanent pacemakers and 14/45 (31%) defined the monitoring procedure for patients in line with current best practice. Only 5/45 (11%) policies defined the radiotherapy tolerance dose to implantable cardioverter defibrillators and 12/45 (27%) defined the monitoring procedure in line with current best practice. Conclusion: Most UK cardiac device policies do not reflect current best evidence. Policies are based on research carried out in

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Irradiation of Pacemakers and Cardio-Defibrillators in Patients Submitted to Radiotherapy: A Clinical Experience

Cited by 34 publications

References 30 publications

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

A National Audit of Current Cardiac Device Policies from Radiotherapy Centres across the UK

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Irradiation of Pacemakers and Cardio-Defibrillators in Patients Submitted to Radiotherapy: A Clinical Experience

Cited by 34 publications

References 30 publications

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203†

A National Audit of Current Cardiac Device Policies from Radiotherapy Centres across the UK

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Product

Resources

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Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†