Radiotherapy-Induced Cardiac Implantable Electronic Device Dysfunction in Patients With Cancer
Autor: | Sébastien X. Joncas, Caroline Lavoie, Luis Nombela-Franco, Mathilde Chamula, Rodrigo Bagur, Yasir Parviz, Valérie Gaudreault, Zeev Israeli, Mamas A. Mamas, Shahar Lavi, N. Varfalvy, Louis Archambault, Anne-Sophie Julien, Émilie Brouillard |
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Rok vydání: | 2017 |
Předmět: |
Male
Pacemaker Artificial medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Cohort Studies 03 medical and health sciences 0302 clinical medicine Risk Factors Neoplasms Internal medicine medicine Humans In patient Aged Aged 80 and over Radiotherapy business.industry Incidence Incidence (epidemiology) Radiation dose Cancer Arrhythmias Cardiac Mean age medicine.disease Defibrillators Implantable Cancer treatment Radiation therapy 030220 oncology & carcinogenesis Total dose Cardiology Equipment Failure Female Cardiology and Cardiovascular Medicine business |
Zdroj: | The American Journal of Cardiology. 119:284-289 |
ISSN: | 0002-9149 |
Popis: | Radiotherapy can affect the electronic components of a cardiac implantable electronic device (CIED) resulting in malfunction and/or damage. We sought to assess the incidence, predictors, and clinical impact of CIED dysfunction (CIED-D) after radiotherapy for cancer treatment. Clinical characteristics, cancer, different types of CIEDs, and radiation dose were evaluated. The investigation identified 230 patients, mean age 78 ± 8 years and 70% were men. A total of 199 patients had pacemakers (59% dual chamber), 21 (9%) cardioverter-defibrillators, and 10 (4%) resynchronizators or defibrillators. The left pectoral (n = 192, 83%) was the most common CIED location. Sixteen patients (7%) experienced 18 events of CIED-D after radiotherapy. Reset to backup pacing mode was the most common encountered dysfunction, and only 1 (6%) patient of those with CIED-D experienced symptoms of atrioventricular dyssynchrony. Those who had CIED-D tended to have a shorter device age at the time of radiotherapy compared to those who did not (2.5 ± 1.5 vs 3.8 ± 3.4 years, p = 0.09). The total dose prescribed to the tumor was significantly greater among those who had CIED-D (66 ± 30 vs 42 ± 23 Gy, p0.0001). Multivariate logistic regression analysis identified the total dose prescribed to the tumor as the only independent predictor for CIED-D (odds ratio 1.19 for each increase in 5 Gy, 95% confidence interval 1.08 to 1.31, p = 0.0005). In conclusion, in this large population of patients with CIEDs undergoing radiotherapy for cancer treatment, the occurrence of newly diagnosed CIED-D was 7%, and the reset to backup pacing mode was the most common encountered dysfunction. The total dose prescribed to the tumor was a predictor of CIED-D. Importantly, although the unpredictability of CIEDs under radiotherapy is still an issue, none of our patients experienced significant symptoms, life-threatening arrhythmias, or conduction disorders. |
Databáze: | OpenAIRE |
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