Radiotherapy-Induced Malfunction in Contemporary Cardiovascular Implantable Electronic Devices

Abstract

In a cohort of contemporary CIEDs, all cases of single-event upset malfunction occurred in the setting of notable neutron production, at a rate of 21% for neutron-producing RT and 0% for non-neutron-producing RT. Where clinically feasible, the use of non-neutron-producing RT is recommended. Given the lack of correlation between CIED malfunction and incident dose observed up to 5.4 Gy, invasive CIED relocation procedures in these settings can be minimized.

A review of implantable cardioverter defibrillator failures during radiation therapy in three Sydney hospitals

“…Similar to recent findings by Zaremba et al . and Grant et al ., this was found not to be dependent on dose per fraction or cumulative dose. One patient required a magnet during treatment due to an expected dose to the ICD of 6.8 Gy.…”

“…noting a fivefold increase in device malfunction when using energies greater than 15 MV. Dose recommendations for ICDs vary between the literature, with recommendations commonly suggesting 1 Gy, but as high as 10 Gy . This paper aims to assist in quantifying the risk of failure based on patient cases documented across three Australian radiation therapy centres.…”

CIED malfunction in patients receiving radiation is a rare event that could be detected by remote monitoring

“…15 These studies report an incidence of RT attributable CIED abnormalities ranging from 1.5% to 7% 10,16,17 with the most commonly identified CIED mal- show that CIED malfunction is a rare event and that many of the events seen in our series, as well as those reported in other series, can be monitored and detected through contemporary remote CIED monitoring systems. 15 These studies report an incidence of RT attributable CIED abnormalities ranging from 1.5% to 7% 10,16,17 with the most commonly identified CIED mal- show that CIED malfunction is a rare event and that many of the events seen in our series, as well as those reported in other series, can be monitored and detected through contemporary remote CIED monitoring systems.…”

Revisiting the impact of radiation therapy on cardiac implantable electronic device (CIED) function

“…5,6,15,19 Although nowadays the use of primary neutron beam RT is rare, a scatter neutron radiation caused by neutrons produced in the head of the linear accelerators upon high energy (>10 MV) photon beam is frequent. 5,6,15,19 Although nowadays the use of primary neutron beam RT is rare, a scatter neutron radiation caused by neutrons produced in the head of the linear accelerators upon high energy (>10 MV) photon beam is frequent.…”