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Radiotherapy-induced Malfunctions of Cardiac Implantable Electronic Devices: a Meta-analysis

  • Author Footnotes
    † Co-first authors / equal contributions.
    Beizheng Xu
    Footnotes
    † Co-first authors / equal contributions.
    Affiliations
    Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
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  • Author Footnotes
    † Co-first authors / equal contributions.
    Yueying Wang
    Footnotes
    † Co-first authors / equal contributions.
    Affiliations
    Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
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  • Gary Tse
    Affiliations
    Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China

    Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration

    Kent and Medway Medical School, Canterbury, Kent, CT2 7NZ, UK
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  • Jiayi Chen
    Affiliations
    Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine Shanghai, China
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  • Guangping Li
    Affiliations
    Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
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  • Panagiotis Korantzopoulos
    Correspondence
    CORRESPONDENCE to: Associate Prof. Panagiotis Korantzopoulos, First Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece.
    Affiliations
    First Department of Cardiology, University of Ioannina, Medical School, Ioannina 45110, Greece
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  • Tong Liu
    Correspondence
    CORRESPONDENCE to: Prof. Tong Liu, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, People’s Republic of China. or
    Affiliations
    Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
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  • Author Footnotes
    † Co-first authors / equal contributions.
Published:January 25, 2023DOI:https://doi.org/10.1016/j.hrthm.2023.01.024

      Abstract

      Background

      Radiation therapy (RT) may pose acute and long-term risks for patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs).

      Objective

      We conducted a systematic review and meta-analysis to examine the association between RT and PMs/ ICDs malfunctions in cancer patients.

      Methods

      We searched the literature using the PubMed, the Cochrane clinical trials database, and the Web of Science and Embase, for relative publications until April 2022. Of the 550 initially identified studies, 17 retrospective observational studies including 2,454 patients were finally analyzed.

      Results

      The meta-analysis showed that RT was associated with an increased risk of ICDs malfunctions (OR 2.75, 95%CI 1.74-4.33). Five studies were included in the subgroup analysis regarding photon beam energy showing that radiation induced CIEDs failure was more likely to occur in ICDs when beam energy was ≥10MV (OR 5.28, 95%CI 2.14-13.03). Neutron-generating RT significantly increased the risk of CIEDs malfunctions (OR 3.97, 95%CI 1.70-9.26), especially the risk of reset (OR 5.79, 95%CI 2.37-14.12, p=0.0001). We did not find significant differences in the risk of CIEDs failure between chest RT and other RT sites (OR 1.09, 95%CI 0.63-1.88).

      Conclusion

      Our meta-analysis suggests that ICDs are more likely to be affected by RT than PMs. These adverse events, especially reset, in cancer patients were associated with neutron-generating RT and beam energy ≥10MV. Given the increasing requirement for RT in several cancer patients as well as the increasing implantation rates of CIEDs, a better risk stratification is needed in this setting.

      Keywords

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