Radiation therapy and cardiac implantable electronic devices: case series review

Radiation therapy for cancer treatment has been shown to impact cardiac implantable electronic device (CIED) function [1-3].

Guideline information indicates a requirement for pre and post radiation therapy device checks according to the type of device and device dependency [4-5].

This study investigated a group of patients undergoing radiation therapy who had a CIED implanted previously. We assessed the adherence to guideline device management and any device malfunction or sensing issue that occurred.

Patients undergoing radiation therapy between 2013 and 2023 who were referred to our centre for CIED assessment prior to therapy were screened and included if necessary data was available. Details of the proposed radiation therapy including body area and calculated dose were obtained.

CIED type and dependency level and any device malfunctions or detected arrhythmia during or after radiotherapy were examined.

Appropriate device management according to local guidelines was recorded.

Baseline device type and dependency were shown in graphical form. Outcomes of the device management and any device issues were displayed within tables.

We collected results for 71 patients. Most patients underwent pre and post radiation therapy checks according to current guidelines.

57 patients had pacemakers, 10 had implantable cardioverter defibrillators and 4 had cardiac resynchronisation therapy devices. Approximately 35% were pacing dependent (figure 1).

Only 9 patients had any device parameter change or detected arrhythmia on the post radiation therapy check (table 1). No significant device issues were detected.

Almost all patients received a calculated radiation dose of <2Gy.

No device malfunction occurred post radiation therapy and only a small proportion of patients had non-significant arrhythmias detected.

There was a high compliance with guideline recommended device management.

Further investigation may be useful into patients undergoing low risk radiation therapy to minimise accumulative device management needs.