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Radiotherapy for patients with cardiovascular implantable electronic devices: an 11-year experience

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

As cardiovascular implantable electronic devices (CIEDs) are increasingly indicated in older patients, and the burden of cancer is rising with the aging population, the management of patients with CIEDs who require radiotherapy (RT) is a timely concern. The objective of the study was to evaluate the management of, and malfunctions in, patients with CIEDs undergoing RT.

Methods

A retrospective study of patients with CIEDs receiving RT at Kingston Health Sciences Center from March 2007–April 2018 was conducted. Data on demographics, RT, devices, and management were compared for the primary outcome of device malfunction.

Results

Of the 189 patients with CIEDs receiving a total of 297 courses of RT, 4 patients (2.1%) experienced device malfunctions. Higher beam energy was associated with a malfunction (p < 0.05). Patients with malfunctions received a lower dose of radiation per fraction (267 ± 93 cGy vs. 477 ± 282 cGy; p < 0.05) and were significantly younger (71.4 ± 2.2 years vs. 77.8 ± 9.8 years; p < 0.01) compared to patients without malfunctions.

Conclusion

RT-induced device malfunctions are rare, but given the potential complications, a better understanding of the potential predictors of malfunction and the development of evidence-based guidelines will help optimize patient safety.

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Authors and Affiliations

  1. Kingston Health Sciences Centre, Kingston, Ontario, K7L 2V7, Canada

    Cynthia Yeung, Bachar Hazim, Debra Campbell, Jim Gooding, Shirley XL Li, Ho Kit Tam, Wilma M. Hopman, Sanoj Chacko, Damian P. Redfearn, Christopher Simpson, Hoshiar Abdollah & Adrian Baranchuk

  2. Kingston General Hospital, Queen’s University, 76 Stuart Street, Kingston, Ontario, K7L 2V7, Canada

    Adrian Baranchuk

Authors
  1. Cynthia Yeung
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  2. Bachar Hazim
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  3. Debra Campbell
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  4. Jim Gooding
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  5. Shirley XL Li
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  6. Ho Kit Tam
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  7. Wilma M. Hopman
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  8. Sanoj Chacko
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  9. Damian P. Redfearn
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  10. Christopher Simpson
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  11. Hoshiar Abdollah
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  12. Adrian Baranchuk
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Corresponding author

Correspondence to Adrian Baranchuk.

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The authors declare that they have no conflict of interest.

Additional information

What’s New?

● Although radiotherapy (RT)-induced device malfunctions are rare, there are no universal evidence-based guidelines for the management of patients with cardiovascular implantable electronic devices (CIEDs) undergoing RT, and considerable variation exists in clinical practice.

● There has been no published literature detailing a formal workflow for the interdisciplinary management of patients with CIEDs requiring RT.

● This manuscript will describe a standardized protocol for the communication and collaboration between the radiation oncology and cardiology departments for the purposes of (i) ensuring patients with CIEDs are safely treated when they require RT, and (ii) minimizing the risk of CIED failure when RT is given; and evaluate the data from the 11-year experience regarding the recommendations and device malfunctions.

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Yeung, C., Hazim, B., Campbell, D. et al. Radiotherapy for patients with cardiovascular implantable electronic devices: an 11-year experience. J Interv Card Electrophysiol 55, 333–341 (2019). https://doi.org/10.1007/s10840-018-0506-0

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  • DOI: https://doi.org/10.1007/s10840-018-0506-0

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