Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2012

Open Access 01-12-2012 | Review

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Authors: Coen W Hurkmans, Joost L Knegjens, Bing S Oei, Ad JJ Maas, GJ Uiterwaal, Arnoud J van der Borden, Marleen MJ Ploegmakers, Lieselot van Erven

Published in: Radiation Oncology | Issue 1/2012

Login to get access

Abstract

Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient’s perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients’ perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well.
Appendix
Available only for authorised users
Literature
1.
Crossley GH, Poole JE, Rozner MA, et al.: The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management this document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Heart Rhythm 2011, 8: 1114-1154. 10.1016/j.hrthm.2010.12.023CrossRefPubMed
2.
Solan AN, Solan MJ, Bednarz G, et al.: Treatment of patients with cardiac pacemakers and implantable cardioverter-defibrillators during radiotherapy. Int J Radiat Oncol Biol Phys 2004, 59: 897-904. 10.1016/j.ijrobp.2004.02.038CrossRefPubMed
3.
Wadasadawala T, Pandey A, Agarwal JP, et al.: Radiation therapy with implanted cardiac pacemaker devices: a clinical and dosimetric analysis of patients and proposed precautions. Clin Oncol (R Coll Radiol) 2011, 23: 79-85. 10.1016/j.clon.2010.08.031CrossRef
4.
Hudson F, Coulshed D, D'Souza E, et al.: Effect of radiation therapy on the latest generation of pacemakers and implantable cardioverter defibrillators: A systematic review. J Med Imaging Radiat Oncol 2010, 54: 53-61. 10.1111/j.1754-9485.2010.02138.xCrossRefPubMed
5.
Snow JS, Kalenderian D, Colasacco JA, et al.: Implanted devices and electromagnetic interference: case presentations and review. J Invasive Cardiol 1995, 7: 25-32.PubMed
6.
7.
Niehaus M, Tebbenjohanns J: Electromagnetic interference in patients with implanted pacemakers or cardioverter-defibrillators. Heart 2001, 86: 246-248.PubMedCentralPubMed
8.
Sundar S, Symonds RP, Deehan C: Radiotherapy to patients with artificial cardiac pacemakers. Cancer Treat Rev 2005, 31: 474-486. 10.1016/j.ctrv.2005.05.002CrossRefPubMed
9.
Tondato F, Ng DW, Srivathsan K, et al.: Radiotherapy-induced pacemaker and implantable cardioverter defibrillator malfunction. Expert Rev Med Devices 2009, 6: 243-249. 10.1586/erd.09.7CrossRefPubMed
10.
Marbach JR, Sontag MR, Van DJ, et al.: Management of radiation oncology patients with implanted cardiac pacemakers: report of AAPM Task Group No. 34. American Association of Physicists in Medicine. Med Phys 1994, 21: 85-90.CrossRefPubMed
11.
Soejima T, Yoden E, NIshimura Y, et al.: Radiation therapy in patients with implanted cardiac pacemakers and implantable cardioverter defibrillators: a prospective survey in Japan. J Radiat Res 2011, 52: 516-521. 10.1269/jrr.10143CrossRefPubMed
12.
Lin JP, Chu TC, Lin SY, et al.: The measurement of photoneutrons in the vicinity of a Siemens Primus linear accelerator. Appl Radiat Isot 2001, 55: 315-321. 10.1016/S0969-8043(01)00084-7CrossRefPubMed
13.
Nath R, Meigooni AS, King CR, et al.: Superheated drop detector for determination of neutron dose equivalent to patients undergoing high-energy x-ray and electron radiotherapy. Med Phys 1993, 20: 781-787. 10.1118/1.597145CrossRefPubMed
14.
Croshaw R, Kim Y, Lappinen E, et al.: Avoiding mastectomy: accelerated partial breast irradiation for breast cancer patients with pacemakers or defibrillators. Ann Surg Oncol 2011, 18: 3500-3505. 10.1245/s10434-011-1784-2CrossRefPubMed
15.
Kim Y, Arshoun Y, Trombetta MG: Pacemaker/implantable cardioverter-defibrillator dose in balloon high-dose-rate brachytherapy for breast cancer treatment. Brachytherapy 2012, 11: 380-386. 10.1016/j.brachy.2012.01.001CrossRefPubMed
16.
Diederich S, Lenzen H: Radiation exposure associated with imaging of the chest: comparison of different radiographic and computed tomography techniques. Cancer 2000, 89: 2457-2460. 10.1002/1097-0142(20001201)89:11+<2457::AID-CNCR22>3.0.CO;2-7CrossRefPubMed
17.
Murphy MJ, Balter J, Balter S, et al.: The management of imaging dose during image-guided radiotherapy: report of the AAPM Task Group 75. Med Phys 2007, 34: 4041-4063. 10.1118/1.2775667CrossRefPubMed
18.
Rodriguez F, Filimonov A, Henning A, et al.: Radiation-induced effects in multiprogrammable pacemakers and implantable defibrillators. Pacing Clin Electrophysiol 1991, 14: 2143-2153. 10.1111/j.1540-8159.1991.tb06485.xCrossRefPubMed
19.
John J, Kaye GC: Shock coil failure secondary to external irradiation in a patient with implantable cardioverter defibrillator. Pacing Clin Electrophysiol 2004, 27: 690-691. 10.1111/j.1540-8159.2004.00513.xCrossRefPubMed
20.
Guidant Corporation Cardiac Rhythm Management Technical Services Revision L02/13/03. The impact of therapeutic radiation on Guidant implantable pacemakers (IPMs) and implantable cardioverter defibrillators (ICDs) 2003, 1-6.
21.
Boston Scientific: Therapeutic Radiation and Implantable Pacemakers and Defibrillators. 2008.
22.
Medtronic USA Inc. Rev. E 22-12-0008. Standard Letter, THERAPEUTIC RADIATION
23.
St.jude Medical Technical Services Rev 11/08. Effects of Therapeutic Radiation on St. Jude Medical Implantable Cardiac Rhythm Devices 2008.
24.
Uiterwaal H, Springorum BG, Scheepers E, et al.: Interference detection in implantable defibrillators induced by therapeutic radiation therapy. Neth Heart J 2006, 14: 330-334.PubMedCentralPubMed
25.
Hurkmans CW, Scheepers E, Springorum BG, et al.: Influence of radiotherapy on the latest generation of implantable cardioverter-defibrillators. Int J Radiat Oncol Biol Phys 2005, 63: 282-289. 10.1016/j.ijrobp.2005.04.047CrossRefPubMed
26.
Hurkmans CW, Scheepers E, Springorum BG, et al.: Influence of radiotherapy on the latest generation of pacemakers. Radiother Oncol 2005, 76: 93-98. 10.1016/j.radonc.2005.06.011CrossRefPubMed
27.
Zweng A, Schuster R, Hawlicek R, et al.: Life-threatening pacemaker dysfunction associated with therapeutic radiation: a case report. Angiology 2009, 60: 509-512. 10.1177/0003319708315305CrossRefPubMed
28.
Mouton J, Haug R, Bridier A, et al.: Influence of high-energy photon beam irradiation on pacemaker operation. Phys Med Biol 2002, 47: 2879-2893. 10.1088/0031-9155/47/16/304CrossRefPubMed
29.
McCollough CH, Zhang J, Primak AN, et al.: Effects of CT irradiation on implantable cardiac rhythm management devices. Radiology 2007, 243: 766-774. 10.1148/radiol.2433060993CrossRefPubMed
30.
Souliman SK, Christie J: Pacemaker failure induced by radiotherapy. Pacing Clin Electrophysiol 1994, 17: 270-273. 10.1111/j.1540-8159.1994.tb01387.xCrossRefPubMed
31.
Kapa S, Fong L, Blackwell CR, et al.: Effects of scatter radiation on ICD and CRT function. Pacing Clin Electrophysiol 2008, 31: 727-732. 10.1111/j.1540-8159.2008.01077.xCrossRefPubMed
32.
Hashimoto T, Isobe T, Hashii H, et al.: Influence of secondary neutrons induced by proton radiotherapy for cancer patients with implantable cardioverter defibrillators. Radiat Oncol 2012, 7: 10. 10 10.1186/1748-717X-7-10PubMedCentralCrossRefPubMed
33.
Franco L, Gomez F, Iglesias A, Pardo J, Pazos A, Pena J, Zapata M Radecs. SEUs on commercial SRAM induced by low energy neutrons produced at a clinical linac facility 2005.
34.
Wilkinson JD, Bounds C, Brown T, Gerbi BJ, Peltier J IEEE Transactions. Cancer-Radiotherapy Equipment as a Cause of Soft Errors in Electronic Equipment. Device and Materials Reliability 2005, 449-451.
35.
Hashii H, Hashimoto T, Okawa A, et al.: Comparison of the Effects of High-Energy Photon Beam Irradiation (10 and 18 MV) on 2 Types of Implantable Cardioverter-Defibrillators. Int J Radiat Oncol Biol Phys 2012, 78: S71-S72.CrossRef
36.
Ferrara T, Baiotto B, Malinverni G, et al.: Irradiation of pacemakers and cardio-defibrillators in patients submitted to radiotherapy: a clinical experience. Tumori 2010, 96: 76-83.PubMed
37.
Gelblum DY, Amols H: Implanted cardiac defibrillator care in radiation oncology patient population. Int J Radiat Oncol Biol Phys 2009, 73: 1525-1531. 10.1016/j.ijrobp.2008.06.1903CrossRefPubMed
38.
Lau DH, Wilson L, Stiles MK, et al.: Defibrillator reset by radiotherapy. Int J Cardiol 2008, 130: e37-e38. 10.1016/j.ijcard.2007.06.145CrossRefPubMed
39.
Nemec J: Runaway implantable defibrillator–a rare complication of radiation therapy. Pacing Clin Electrophysiol 2007, 30: 716-718. 10.1111/j.1540-8159.2007.00735.xCrossRefPubMed
40.
Tsekos A, Momm F, Brunner M, et al.: The cardiac pacemaker patient–might the pacer be directly irradiated? Acta Oncol 2000, 39: 881-883. 10.1080/028418600750063668CrossRefPubMed
41.
Hauser RG, Hayes DL, Epstein AE, et al.: Multicenter experience with failed and recalled implantable cardioverter-defibrillator pulse generators. Heart Rhythm 2006, 3: 640-644. 10.1016/j.hrthm.2006.02.011CrossRefPubMed
42.
Lelakowski J, Majewski J, Bednarek J, et al.: Pacemaker dependency after pacemaker implantation. Cardiol J 2007, 14: 83-86.PubMed
43.
Korantzopoulos P, Letsas KP, Grekas G, et al.: Pacemaker dependency after implantation of electrophysiological devices. Europace 2009, 11: 1151-1155. 10.1093/europace/eup195CrossRefPubMed
44.
Vardas PE, Auricchio A, Blanc JJ, et al.: Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. Eur Heart J 2007, 28: 2256-2295.CrossRefPubMed
45.
Sears SF, Hauf JD, Kirian K, et al.: Posttraumatic stress and the implantable cardioverter-defibrillator patient: what the electrophysiologist needs to know. Circ Arrhythm Electrophysiol 2011, 4: 242-250. 10.1161/CIRCEP.110.957670CrossRefPubMed
46.
Habibovic M, van den Broek KC, Alings M, et al.: Posttraumatic stress 18 months following cardioverter defibrillator implantation: shocks, anxiety, and personality. Health Psychol 2012, 31: 186-193.CrossRefPubMed
47.
Bostwick JM, Sola CL: An updated review of implantable cardioverter/defibrillators, induced anxiety, and quality of life. Heart Fail Clin 2011, 7: 101-108. 10.1016/j.hfc.2010.10.003CrossRefPubMed
48.
Wilkoff BL, Love CJ, Byrd CL, et al.: Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm 2009, 6: 1085-1104. 10.1016/j.hrthm.2009.05.020CrossRefPubMed
49.
de Bie MK, van Rees JB, Thijssen J, et al.: Cardiac device infections are associated with a significant mortality risk. Heart Rhythm 2012, 9: 494-498. 10.1016/j.hrthm.2011.10.034CrossRefPubMed
50.
Gould PA, Krahn AD: Complications associated with implantable cardioverter-defibrillator replacement in response to device advisories. JAMA 2006, 295: 1907-1911. 10.1001/jama.295.16.1907CrossRefPubMed
51.
Borleffs CJ, Thijssen J, de Bie MK, et al.: Recurrent implantable cardioverter-defibrillator replacement is associated with an increasing risk of pocket-related complications. Pacing Clin Electrophysiol 2010, 33: 1013-1019.PubMed
52.
Munshi A, Wadasadawala T, Sharma PK, et al.: Radiation therapy planning of a breast cancer patient with in situ pacemaker–challenges and lessons. Acta Oncol 2008, 47: 255-260. 10.1080/02841860701678779CrossRefPubMed
53.
Wilm M, Kronholz HL, Koch T: Beeinflussung programmierbarer schrittmacher durch therapeutische bestralungen. Strahlenther Onkol 1994, 170: 225-231.PubMed
Metadata
Title
Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands
Authors
Coen W Hurkmans
Joost L Knegjens
Bing S Oei
Ad JJ Maas
GJ Uiterwaal
Arnoud J van der Borden
Marleen MJ Ploegmakers
Lieselot van Erven
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-7-198

Other articles of this Issue 1/2012

Radiation Oncology 1/2012 Go to the issue

Study protocol

Multimodal hypoxia imaging and intensity modulated radiation therapy for unresectable non-small-cell lung cancer: the HIL trial

Research

Radiochemoimmunotherapy with intensity-modulated concomitant boost: interim analysis of the REACH trial

Research

Gold marker displacement due to needle insertion during HDR-brachytherapy for treatment of prostate cancer: A prospective cone beam computed tomography and kilovoltage on-board imaging (kV-OBI) study

Research

NVP-BEZ235 and NVP-BGT226, dual phosphatidylinositol 3-kinase/mammalian target of rapamycin inhibitors, enhance tumor and endothelial cell radiosensitivity

Research

Neoadjuvant chemoradiation with Gemcitabine for locally advanced pancreatic cancer

Research

Interim-treatment quantitative PET parameters predict progression and death among patients with hodgkin's disease