Expanded survival of patients with conduction system disease, heart failure, and history of sudden cardiac arrest owing to many medical advances including cardiovascular implantable electronic devices (CIEDs) such as pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) has increased the likelihood that they may encounter the need for radiation therapy (RT) in the treatment for cancer. Yet case reports of runaway continuous high-rate pacing or inappropriate shocks, coupled with guidelines now more than 2 decades old,1 can heighten the anxiety of both radiation oncology and cardiac electrophysiology specialists in the care of patients with CIEDs undergoing RT. Manufacturer guidelines are also inconsistent; therefore, considerable variation in clinical practice exists with respect to RT planning and monitoring.2
Tseng ZH. Risk of Cardiovascular Implantable Electronic Device Malfunction With Radiation Therapy: Location, Dose, or Energy? JAMA Intern Med. 2015;175(10):1698–1699. doi:10.1001/jamainternmed.2015.4128
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