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Patients with implantable cardiac devices undergoing radiation therapy: a single center experience
Session:
Posters (Sessão 2 - Écran 1) - Arritmias - miscelânea
Speaker:
Fernando Guilherme Ribeiro Mané
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.7 Arrhythmias, General – Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Fernando Ribeiro Mané; Inês Conde; Rodrigo Silva; Rui Flores; Sofia Ramos; Marina Amorim; Maria Rodrigues; Cristiana Braga; Catarina Barbosa; Sandra Paiva; Paulo Medeiros; Sónia Magalhães; Carina Arantes; Adília Rebelo; Sérgia Rocha
Abstract
<p style="text-align:justify">INTRODUCTION: Radiation therapy is a known risk factor for cardiac implantable electronic devices (CIEDs) malfunction. However, the management of CIEDs during radiotherapy is heterogeneous across centers and the frequency of complications is variable.</p> <p> </p> <p>OBJECTIVE: We aimed to evaluate the prevalence of CIED malfunction in patients submitted to radiotherapy after adequate risk stratification and management according to a predefined protocol.</p> <p> </p> <p>METHODS: Retrospective observational cohort study that included patients with CIEDs chronically followed in our center and submitted to radiotherapy. CIED management during the treatment period was conducted according to pre-defined institutional protocol (Figure 1). Data were collected on patient and device baseline characteristics, radiation exposure during treatment (two main measures: cumulative dose (Gy) and photon energy (mV)) and CIEDs malfunction events.</p> <p> </p> <p>RESULTS</p> <p>We included 55 patients with a mean age of 77±10 years. Most patients were male (72%). Median follow-up was 18 months. Ten percent of patients were defibrillator carriers, as most were pacemaker carriers (90%). Of these, 28% were pacemaker dependent.</p> <p>Regarding radiation exposure, the most common treatment region was pelvic-prostatic (47%), followed by thoracic (19%), yet only 1 patient had the CIED located in the clinical target volume (2%). When radiation dose was analyzed, only 1 patient had cumulative dose on device > 20Gy (defined as high dose) and 3 (5%) patients had intermediate low range doses (2-5 Gy). Despite these results, analysis of photon energy demonstrates that most patients (75%) were exposed to neutron generating energy (>10MV). The sample was mainly classified as low risk according to the institution protocol (70%), followed by intermediate risk (28%), and only 1 patient was classified as high-risk (2%).</p> <p>Device malfunction was detected in 1 patient (2%), and specifics are presented in table 1.</p> <p> </p> <p>DISCUSSION:</p> <p>Radiotherapy is safe in patients with CIEDs when adequate surveillance and follow-up is undergone, as was observed in this cohort. Nonetheless, the major criteria used to stratify patients is dubious and may lead to misclassifications of risk. In our sample many</p> <p>patients were exposed to neutron generating energy, with potentially more risk of CIED malfunction but not frequently included in most protocols regarding device management. As events are so rare, larger studies are needed to improve risk management in this population.</p>
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