Radiotherapy and risk of implantable cardioverter-defibrillator malfunctions: experimental data from direct exposure at increasing doses

Zecchin, Massimo; Artico, Jessica; Morea, Gaetano; Severgnini, Mara; Bianco, Elisabetta; Luca, Antonio De; Fantasia, Anna Zorzin; Salvatore, Luca; Milan, V.; Lucarelli, Matteo; Dissegna, Roberta; Cannatà, Antonio; Sinagra, Gianfranco

doi:10.2459/jcm.0000000000000623

Cited by 8 publications

(3 citation statements)

References 22 publications

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“…The cut‐off value of 2 Gy was chosen according with current guidelines, 3 , 48 but our sub‐analysis failed to reach statistical significance (RR 0.93, 95% CI: 0.31–2.76). In a recent in vitro study, 49 19 explanted ICDs were irradiated with a 6‐MV photon beam reaching an increasing cumulative dose at ICD sites of 0.5, 1, 2, 3, 5 and 10 Gy. After radiation, the authors showed no CIED malfunctions or electromagnetic interferences.…”

Section: Discussionmentioning

confidence: 99%

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

Malavasi

Imberti

Tosetti

et al. 2022

Eur J Clin Investigation

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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.

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Section: Discussionmentioning

confidence: 99%

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

Malavasi

Imberti

Tosetti

et al. 2022

Eur J Clin Investigation

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“…However, these effects were not considered in the present study, since they are easily preventable by avoiding direct irradiation. Electromagnetic interference (EMI) is also not considered as a cause of malfunction because no recent studies on radiotherapy have reported that it is related to malfunction, although some malfunctions to older PMs, before 1990, were reported …”

Section: Methodsmentioning

confidence: 99%

“…Although the photon dose at malfunction was again randomly scattered, they found that malfunction occurred only in the use of neutron‐producible beams, e.g., 15‐MV and 18‐MV beams of X‐rays. Recent studies, and particularly of proton therapy, also suggested the contribution of neutrons to malfunction. In spite of such numerous studies, however, a quantitative understanding of malfunction has not been reached.…”

Section: Introductionmentioning

confidence: 99%

Prediction of radiation‐induced malfunction for cardiac implantable electronic devices (CIEDs)

Matsubara¹,

Ezura²,

Hashimoto³

et al. 2020

Medical Physics

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Purpose Cardiac implantable electronic devices (CIEDs) were believed to possess a tolerance dose to malfunction during radiotherapy. Although recent studies have qualitatively suggested neutrons as a cause of malfunction, numerical understanding has not been reached. The purpose of this work is to quantitatively clarify the contribution of secondary neutrons from out‐of‐field irradiation to the malfunction of CIEDs as well as to deduce the frequency of malfunctions until completion of prostate cancer treatment as a typical case. Materials and Methods Measured data were gathered from the literature and were re‐analyzed. Firstly, linear relationship for a number of malfunctions to the neutron dose was suggested by theoretical consideration. Secondly, the accumulated number of malfunctions of CIEDs gathered from the literature was compared with the prescribed dose, scattered photon dose, and secondary neutron dose for analysis of their correlation. Thirdly, the number of malfunctions during a course of prostate treatment with high‐energy X‐ray, passive proton, and passive carbon‐ion beams was calculated while assuming the same response to malfunctions, where X‐rays consisted of 6‐MV, 10‐MV, 15‐MV, and 18‐MV beams. Monte Carlo simulation assuming simple geometry was performed for the distribution of neutron dose from X‐ray beams, where normalization factors were applied to the distribution so as to reproduce the empirical values. Results Linearity between risk and neutron dose was clearly found from the measured data, as suggested by theoretical consideration. The predicted number of malfunctions until treatment completion was 0, 0.02 ± 0.01, 0.30 ± 0.08, 0.65 ± 0.17, 0.88 ± 0.50, and 0.14 ± 0.04 when 6‐MV, 10‐MV, 15‐MV, 18‐MV, passive proton, and passive carbon‐ion beams, respectively, were employed, where the single model response to a malfunction of 8.6 ± 2.1 Sv−1 was applied. Conclusions Numerical understanding of the malfunction of CIEDs has been attained for the first time. It has been clarified that neutron dose is a good scale for the risk of CIEDs in radiotherapy. Prediction of the frequency of malfunction as well as discussion of the risk to CIEDs in radiotherapy among the multiple modalities have become possible. Because the present study quantitatively clarifies the neutron contribution to malfunction, revision of clinical guidelines is suggested.

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Effects of high-energy photon beam radiation therapy on Jarvik 2000 LVAD: in vitro evaluation

et al. 2020

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Radiotherapy and risk of implantable cardioverter-defibrillator malfunctions: experimental data from direct exposure at increasing doses

Cited by 8 publications

References 22 publications

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

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

Prediction of radiation‐induced malfunction for cardiac implantable electronic devices (CIEDs)

Effects of high-energy photon beam radiation therapy on Jarvik 2000 LVAD: in vitro evaluation

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