Abstract 20204: CIED Malfunction in Patients Receiving Radiation is a Rare Event That Could Be Detected by Remote Monitoring
Introduction: An increasing number of patients with cardiac devices require radiation therapy for treatment of a variety of cancers. The most recent guidelines from 1994 and small studies have tried to address the issue of radiation therapy in patients with cardiac implantable electronic devices (CIED). This study aimed to identify the incidence and predictors of CIED malfunction in a real-world population that has received radiation therapy.
Hypothesis: CIED malfunction is a rare event that cannot be predicted by radiation data.
Methods: This retrospective cohort study included 110 patients [61 with pacemakers (PM) and 49 with automatic implantable cardioverter defibrillators (AICDs) who received radiation therapy at the University of Rochester. Subjects received either high energy (16MV) and/or low energy (6MV) photon beams with or without electron beams (6-16 MeV). We included interrogations done from 1st day of radiation and up to three months post-radiation therapy. Outcomes analyzed were device-related malfunctions and device-related clinical events.
Results: We identified 6 CIED related events (3 dual-chamber PM, one single chamber PM and 2 AICDs). Four of the six CIED had been implanted more than nine years prior to the events. There were no cases of lead or generator failure requiring an urgent intervention due to radiation therapy. All events were minor and included a case of partial settings reset leading to loss of historical data, two cases of pacing thresholds changes, two cases of lead impedance changes, and one case of LV output increase. Two alerts were detected during remote monitoring while the others during in-person interrogations. Two patients had device-related clinical events, including dyspnea and diaphragmatic-stimulation. Using a logistic regression model, there was no significant statistical association between adverse events and with beam energy type, CIED location, or dose of radiation delivered to the target.
Conclusions: CIED malfunctions are uncommon in real-world patients and associated with minor clinical events. In our cohort, remote CIED monitoring would have identified all radiation related events. The use of remote CIED monitoring during radiation therapy may improve CIED event detection.
Author Disclosures: V. Samala: None. K. Bravo: None. G. Fernandez: None. M.J. Moravan: None. S. Dhakal: None. A.H. Shah: None. M.K. Aktas: None.
- © 2016 by American Heart Association, Inc.