Radiotherapy-induced malfunctions of cardiac implantable electronic devices in cancer patients
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Radiotherapy‑induced malfunctions of cardiac implantable electronic devices in cancer patients Vincenzo L. Malavasi1 · Giuseppina De Marco2 · Jacopo F. Imberti1 · Filippo Placentino1 · Marco Vitolo1 · Ercole Mazzeo2 · Gianfranco Cicoria3 · Edoardo Casali1 · Vincenzo Turco1 · Frank Lohr2 · Giuseppe Boriani1 Received: 20 July 2019 / Accepted: 19 November 2019 © Società Italiana di Medicina Interna (SIMI) 2019
Abstract The number of patients with cardiac implantable electronic devices (CIEDs) requiring radiation therapy (RT) for cancer treatment is increasing. The purpose of this study is to estimate the prevalence, possible predictors, and clinical impact of RT-related CIEDs malfunctions. We retrospectively reviewed the medical records of all pacemaker (PM)/implantable cardioverter-defibrillator (ICD) patients who underwent RT in the last 14 years. One hundred and twenty-seven patients who underwent 150 separate RT courses were analysed (99 with a PM and 27 with an ICD). Of note, 21/127 (16.6%) patients were PM-dependent. Neutron-producing RT was used in 37/139 (26.6%) courses, whereas non-neutron-producing RT was used in 102/139 (73.4%) courses. The cumulative dose (Dmax) delivered to the CIED exceeded 5 Gy only in 2/132 (1.5%) cases. Device malfunctions were observed in 3/150 (2%) RT courses, but none was life-threatening or led to a major clinical event and all were resolved by CIED reprogramming. In all cases, the Dmax delivered to the CIED was 10 cm, we assumed that the Dmax delivered to the CIED was 10 MV), and non-neutron-producing (photon beam energy ≤ 10 MV and electron beam energy ≤ 18 MeV). While neutron production starts at 7 MV, the neutron component is still relatively low at 10 MV; we, therefore, choose this energy as the cut-off [6, 9] In accordance with the current literature [10], zone of radiation exposure was classified in Zone 1; upper head: virtual line including nose–ears. Zone 2, lower head and neck: virtual line below nose–ears and up to the neck. Zone 3: chest and pectoral including shoulders and upper third of the arms. Zone 4: abdomen and including medium third of the arms. Zone 5: pelvis and including lower third of the arms and upper third of the lower limb. Zone 6: medium and lower thirds of lower limb.
Statistical analysis Statistical analysis was performed using SPSS® (version 22). Continuous variables are expressed as median and interquartile range (IQR). Binary variables are expressed as counts and percentages. Bivariate analyses were conducted with Fisher’s exact test, Chi-square test, and Mann–Whitney test. In all analyses, a p value
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