Effect of radiation therapy on permanent pacemaker and implantable cardioverter-defibrillator function
Effect of radiation therapy on permanent pacemaker and implantable cardioverter-defibrillator function
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DOI：
10.1016/j.hrthm.2012.08.018
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发表时间：
2012-12-01
期刊：
影响因子：
5.5
通讯作者：
Pelosi, Frank, Jr.
中科院分区：
文献类型：
--
作者：
Makkar, Akash;Prisciandaro, Joann;Pelosi, Frank, Jr.
背景 放射治疗 (RT) 对心脏植入式电子设备 (CIED)（如植入式心律转复除颤器 (ICD) 和起搏器 (PM)）的影响尚未明确，导致在准备 RT 时移除或重新安置设备。 目的 确定分散放疗对 CIED 性能的影响。 方法 我们分析了 69 名患者，其中 50 名 (72%) 患有 PM 和 19 名 (28%) 接受 ICD密歇根大学的 RT。收集的数据包括设备模型、解剖位置、治疗光束能量、治疗类型和设备的估计剂量。患者接受高能 (16-MV) 和/或低能 (6 MV) 光子束（有或没有电子束 (6-16 MeV)）治疗。根据患者对设备的依赖性以及估计或测量的输送剂量，在 RT 前和 RT 后和/或每周在治疗中或家庭询问时对设备进行询问。分析的结果包括不适当的 ICD 治疗、设备故障或设备相关的临床事件。 结果 PM 暴露于 84.4 +/- 99.7 cGy 的辐射，ICD 暴露于 92.1 +/- 72.6 cGy 的辐射。两名装有 ICD 的患者分别在接受 123 cGy 和 4 cGy 后经历了 ICD 的部分重置，历史诊断数据丢失。 RT 完成后 6 个月的随访中，未观察到设备故障或电池过早耗尽。 结论 由于间接 RT 暴露导致的 CIED 故障并不常见。应定期进行治疗或家庭询问，以发现和治疗这些事件并确保保存诊断数据。
BACKGROUND Radiation therapy's (RT's) effects on cardiac implantable electronic devices (CIEDs) such as implantable cardioverter-defibrillators (ICDs) and pacemakers (PMs) are not well established, leading to device removal or relocation in preparation for RT.OBJECTIVE To determine the effect of scattered RT on CIED performance.METHODS We analyzed 69 patients-50 (72%) with PMs and 19 (28%) with ICDs-receiving RT at the University of Michigan. Collected data included device model, anatomic location, and treatment beam energies, treatment type, and estimated dose to the device. Patients were treated with either high-energy (16-MV) and/or low-energy (6 MV) photon beams with or without electron beams (6-16 MeV). The devices were interrogated with pre- and post-RT and/or weekly with either in-treatment or home interrogation, depending on the patient's dependence on the device and the estimated or measured delivered dose. Outcomes analyzed were inappropriate ICD therapies, device malfunctions, or device-related clinical events.RESULTS The PMs were exposed to 84.4 +/- 99.7 cGy of radiation, and the ICDs were exposed to 92.1 +/- 72.6 cGy of radiation. Two patients with ICDs experienced a partial reset of the ICD with the loss of historic diagnostic data after receiving 123 and 4 cGy, respectively. No device malfunction or premature battery depletion was observed at 6-month follow-up from RT completion.CONCLUSIONS CIED malfunction due to indirect RT exposure is uncommon. Regular in-treatment or home interrogation should be done to detect and treat these events and to ensure that diagnostic data are preserved.