Pacemaker function during irradiation: in vivo and in vitro effect

Ngu, SF; O'meley, P.; Johnson, Neva; Collins, C L

doi:10.1111/j.1440-1673.1993.tb00027.x

Cited by 14 publications

(6 citation statements)

References 13 publications

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“…The effect of ionizing radiation on pacemaker and ICD has been extensively analyzed in the literature by in vitro studies 6,8,10,[16][17][18][19][20][21][22][23][24][25]31 . A large number of studies has covered the more modern types of pacemakers 6,17,18,32,33 , but study groups are small, in vitro and only some types of stimulators are included.…”

Section: Discussionmentioning

confidence: 99%

“…The few data available in vivo are mainly on case reports. There are no uniform recommendations from the manufacturers, and these data are of difficult availability (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

“…Few papers have reported clinical experience on patients with pacemakers or implantable cardioverter-defibrillators (ICD) and the application of radiotherapy, and those that have are mainly case reports with a shortage of retrospective or prospective studies (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] . Moreover, most of them have been performed in vitro and reported more or less similar results, i.e., each type of pacemaker may differ in its individual reaction to radiation 8,10,[16][17][18][19][20][21][22][23][24][25] .…”

Section: Introductionmentioning

confidence: 99%

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

Ferrara¹,

Baiotto²,

Malinverni³

et al. 2010

Tumori

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Our study confirms the safety of radiotherapy for patients implanted with pacemakers or implantable cardioverter-defibrillators but suggests that chemoradiation represents a probable risk factor for cardiac toxicity. Furthermore, all cardiac events were observed in patients treated in the head and'neck or left thoracic areas. A standardized protocol is advisable in order to improve patient control during the radiotherapy treatment. It is mandatory to calculate the dose received at the pacemaker/heart, even in the case of palliative treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ferrara¹,

Baiotto²,

Malinverni³

et al. 2010

Tumori

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“…Studies with observational findings report the occurrence of EMI during radiation therapy, [31][32][33] whereas other observational studies and case reports indicate no apparent EMI effects (Category B2-B3 evidence). 34,35 Studies with observational findings report the occurrence of EMI during lithotripsy, 36,37 whereas other observational studies and case reports indicate no apparent EMI effects (Category B2-B3 evidence). 38 -41 No studies were found that reported EMI during electroconvulsive therapy (ECT) (Category D evidence).…”

Section: Preoperative Preparationmentioning

confidence: 99%

Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter-Defibrillators

2011

Anesthesiology

155

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This article has been selected for the ANESTHESIOLOGY CME Program. Learning objectives and disclosure and ordering information can be found in the CME section at the front of this issue. P RACTICE advisories are systematically developed reports that are intended to assist decision-making in areas of patient care. Advisories are based on a synthesis of scientific literature and analysis of expert opinion, clinical feasibility data, open forum commentary, and consensus surveys. Advisories developed by the American Society of Anes-thesiologists (ASA) are not intended as standards, guidelines, or absolute requirements, and their use cannot guarantee any specific outcome. They may be adopted, modified, or rejected according to clinical needs and constraints. The use of practice advisories cannot guarantee any specific outcome. Practice advisories summarize the state of the literature and report opinions obtained from expert consultants and ASA members. Practice advisories are not supported by scientific literature to the same degree as standards or guidelines because of the lack of sufficient numbers of adequately controlled studies. Practice advisories are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. This document updates the "Practice Advisory for the Perioperative Management of Patients with Cardiac Rhythm Management Devices: Pacemakers and Implantable Cardioverter-Defibrillators, adopted by the ASA in 2004 and published in 2005.* Methodology A. Definition of Cardiac Implantable Electronic Devices For this Advisory, a cardiac implantable electronic device (CIED) refers to any permanently implanted cardiac pacemaker or any implantable cardioverter-defibrillator (ICD). The term CIED also refers to any cardiac resynchronization device. † B. Purposes of the Advisory The purposes of this Advisory update are to (1) facilitate safe and effective perioperative management of the patient with a CIED and (2) reduce the incidence of adverse outcomes. Perioperative management refers to the preoperative, intraoperative, postop-Updated by the

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“…Radiation therapy is known to have an effect on pacemaker and implantable cardioverter-defibrillator function [ 6 ] via electromagnetic interference or through the effects of ionizing radiation [ 7 – 11 ]. The effects of radiation therapy on pacemakers has been studied in detail in the past [ 11 – 16 ]. Based on the studies’ results, the American Association of Physicists in Medicine (AAPM) presented recommendations for irradiation of pacemaker patients in 1994 [ 7 ] and divided the hazards into two categories—electromagnetic noise interference and radiation damage.…”

Section: Introductionmentioning

confidence: 99%

Monitoring of CRT-D devices during radiation therapy in vitro

et al. 2016

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BackgroundUsing of active cardiac medical devices increases steadily. In Europe, there were 183 implants of ICD and 944 implants of PM, 119 of biventricular ICD and 41 of biventricular PM, all per million inhabitants in 2014. Healthcare environments, including radiotherapy treatment rooms, are considered challenging for these implantable devices. Exposure to radiation may cause the device to experience premature elective replacement indicator, decreased pacing amplitude or pacing inhibition, inappropriate shocks or inhibition of tachyarrhythmia therapy and loss of device function. These impacts may be temporary or permanent. The aim of this study was to evaluate the influence of linear accelerator ionizing radiation dose of 10 Gy on the activity of the biventricular cardioverter-defibrillator in different position in radiation beam.MethodsTwo identical wireless communication devices with all three leads were used for the measurement. Both systems were soused into solution saline and exposed in different position in the beam of linear accelerator per 10 Gy fractions. In comparison of usually used maximum recommended dose of 2 Gy, the radiation doses used in test were five times higher. Using the simultaneous monitoring wireless communication between device and its programmer allowed watching of the devices activities, noise occurrence or drop of biventricular pacing on the programmer screen, observed by local television loop camera.ResultsAt any device position in radiation beam, there were no influences of the device activity at dose of 10 Gy neither a significant increase of a solution saline temperature in any of the measured positions of CRT-D systems in linear accelerator.ConclusionsThe results of the study indicated, that the recommendation dose for treating the patients with implantable devices are too conservative and the risk of device failure is not so high. The systems can easily withstand the dose fractions of tens Gy, which would allow current single-dose-procedure treatment in radiation therapy. Even though the process of the random alteration of device memory and electrical components by scatter particles not allowed to specify a safe dose during ionizing radiation, this study showed that the safe limit are above the today used dose fractions.

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Pacemaker function during irradiation: in vivo and in vitro effect

Cited by 14 publications

References 13 publications

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

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

Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter-Defibrillators

Monitoring of CRT-D devices during radiation therapy in vitro

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