Delivery of radiation therapy to a pacemaker or implantable cardioverter defibrillator (ICD) may or may not affect the device's function. Hurkmans et al studied the impact of radiation therapy and made recommendations for managing an affected patient. The authors are from Catharina Hospital Eindhoven and the Dutch Society of Radiotherapy and Oncology.
Patient selection: pacemaker or ICD (cardiac implantable electronic devices, CIED) , requiring radiation therapy, especially to the neck and thorax
Parameters:
(1) cumulative dose in Gray (Gy) to be delivered to the device
(2) pacing status (dependent vs independent)
|
Cumulative Dose
|
Pacing Status
|
Risk
|
|
< 2
|
independent
|
low
|
|
< 2
|
dependent
|
medium
|
|
2 to 10
|
NA
|
medium
|
|
> 10
|
NA
|
high
|
Additional information to obtain:
(1) ability to temporarily deactivate the ICD with a magnet in order to avoid unnecessary shocks during the therapy
(2) ability to place and utilize an external pacemaker
(3) input from the treating cardiologist
Interventions may include:
(1) Shielding or redirecting the radiation in order to reduce the amount of radiation affecting the sensor.
(2) Avoiding beam energies above 10 MV (due to high neutron production)
(3) Consider relocating the device.
(4) Being prepared for device malfunction with trained people and equipment available.
(5) Checking the device more often based on the risk level.
