Safety of Contemporary Radiation Therapy in Patients With Cardiac Implantable Electronic Devices: Implications for Clinical Practice

Authors

Kaveh Karimzad
Shalin Shah
Stephen F Kry
Christopher Peeler
Julianne Pollard-Larkin
Amit Koduri
Martin Chacon Portillo
Siddharth Chauhan
Atia Amatullah
Chase Miller
Amanda Strang
Juhee Song
Khatera Mir Zaman Shah
Donelo Lopez
Darla Wagner
January Tsai
Shital Vachhani
Dilip Thakar
Cezar Iliescu
Jean-Bernard Durand
Anne H Dougherty
Bharat Kantharia
Anita Deswal

Publication Date

8-22-2025

Journal

Journal of the American Heart Association Journal

DOI

10.1161/JAHA.125.042937

PMID

40847479

Abstract

Background: Radiation therapy (RT) can cause cardiac implantable electronic device (CIED) malfunction, primarily reset. Given changes in RT and CIED technologies, large observational studies examining malfunction of contemporary CIEDs during modern-day RT are needed to guide clinical practice.

Methods: Electronic medical records of all consecutive patients with CIEDs who underwent RT at a large tertiary cancer center between January 2015 and January 2022 were reviewed. All patients had CIED interrogation before and after completion of RT. Device-related data and RT-specific variables were collected. Statistical analyses were performed at the RT course level.

Results: Over a period of 7 years, 677 patients (median age, 74 [interquartile range, 67. 8-79.2] years; 72% men) with CIEDs (498 [66%] pacemakers and 254 [34%] implantable cardioverter-defibrillators) underwent 752 courses of RT (photon, 83.5%; proton, 10.5%; electron, 6%). Only 9 patients (1.3%) underwent CIED relocation before RT. Device malfunction was observed during 8 RT courses (1.1%), primarily soft reset with data loss. All device malfunctions were observed with neutron-producing radiation (proton and photon >10 MV). CIED type (pacemaker or implantable cardioverter-defibrillator), magnetic resonance imaging conditional or nonconditional system, and radiation site (thorax or nonthorax) did not show statistical differences between RT courses with reset versus no reset. No transient signal interference or oversensing due to RT was recognized by the CIED.

Conclusions: CIED malfunction is a rare complication of contemporary RT, occurring primarily with neutron-producing radiation, most of CIED malfunction cases are without serious clinical consequences. Transient signal interference and oversensing during RT does not appear to be a clinical concern in contemporary CIEDs.

Published Open-Access

yes

Recommended Citation

Karimzad, Kaveh; Shah, Shalin; Kry, Stephen F; et al., "Safety of Contemporary Radiation Therapy in Patients With Cardiac Implantable Electronic Devices: Implications for Clinical Practice" (2025). Faculty, Staff and Student Publications. 4656.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4656