Radiotherapy-induced malfunctions of cardiac implantable electronic devices: A meta-analysis.

Humans Pacemaker, Artificial / adverse effects Retrospective Studies Defibrillators, Implantable / adverse effects Neoplasms / complications
Cardiac implantable electronic devices Implantable cardioverter-defibrillators Malfunction Meta-analysis Pacemakers Radiation therapy

Journal

Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317

Informations de publication

Date de publication:
05 2023
Historique:
received: 08 09 2022
revised: 18 12 2022
accepted: 20 01 2023
medline: 1 5 2023
pubmed: 29 1 2023
entrez: 28 1 2023
Statut: ppublish

Résumé

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). We conducted a systematic review and meta-analysis to examine the association between RT and PM/ICD malfunctions in patients with cancer. We searched the literature using the PubMed, the Cochrane Library the Web of Science, and Embase for relative publications until April 2022. Of the 550 initially identified studies, 17 retrospective observational studies including 2454 patients were finally analyzed. The meta-analysis showed that RT was associated with an increased risk of ICD malfunctions (odds ratio [OR] 2.75; 95% confidence interval [CI] 1.74-4.33). Five studies were included in the subgroup analysis regarding photon beam energy, showing that radiation-induced CIED failure was more likely to occur in ICDs when beam energy was ≥10 MV (OR 5.28; 95% CI 2.14-13.03). Neutron-generating RT significantly increased the risk of CIED 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 = .0001). We did not find significant differences in the risk of CIED failure between chest RT and other RT sites (OR 1.09; 95% CI 0.63-1.88). Our meta-analysis suggests that ICDs are more likely to be affected by RT than PMs. These adverse events, especially reset, in patients with cancer were associated with neutron-generating RT and beam energy ≥10 MV. Given the increasing requirement for RT in several patients with cancer as well as the increasing implantation rates of CIEDs, a better risk stratification is needed in this setting.

Sections du résumé

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 PM/ICD malfunctions in patients with cancer.
METHODS
We searched the literature using the PubMed, the Cochrane Library the Web of Science, and Embase for relative publications until April 2022. Of the 550 initially identified studies, 17 retrospective observational studies including 2454 patients were finally analyzed.
RESULTS
The meta-analysis showed that RT was associated with an increased risk of ICD malfunctions (odds ratio [OR] 2.75; 95% confidence interval [CI] 1.74-4.33). Five studies were included in the subgroup analysis regarding photon beam energy, showing that radiation-induced CIED failure was more likely to occur in ICDs when beam energy was ≥10 MV (OR 5.28; 95% CI 2.14-13.03). Neutron-generating RT significantly increased the risk of CIED 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 = .0001). We did not find significant differences in the risk of CIED 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 patients with cancer were associated with neutron-generating RT and beam energy ≥10 MV. Given the increasing requirement for RT in several patients with cancer as well as the increasing implantation rates of CIEDs, a better risk stratification is needed in this setting.

Identifiants

DOI: 10.1016/j.hrthm.2023.01.024 PMID: 36708909
pubmed: 36708909
pii: S1547-5271(23)00107-8
doi: 10.1016/j.hrthm.2023.01.024
pii:
doi:

Types de publication

Systematic Review Meta-Analysis Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

689-698

Informations de copyright

Copyright © 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Auteurs

Beizheng Xu (B)

Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.

Yueying Wang (Y)

Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.

Gary Tse (G)

Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, Hong Kong; Kent and Medway Medical School, Canterbury, Kent, United Kingdom; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.

Jiayi Chen (J)

Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Guangping Li (G)

Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.

Panagiotis Korantzopoulos (P)

First Department of Cardiology, University of Ioannina, Medical School, Ioannina, Greece. Electronic address: p.korantzopoulos@yahoo.gr.

Tong Liu (T)

Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China. Electronic address: liutong@tmu.edu.cn.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Radiotherapy-induced malfunctions of cardiac...
questionsmedicales.fr › Équipement et fournitures › Équipement et fournitures électriques › Électrodes › Pacemaker › Radiotherapy-induced malfunctions of cardiac...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Radiotherapy-induced malfunctions of cardiac...
questionsmedicales.fr › Équipement et fournitures › Prothèses et implants › Électrodes implantées › Défibrillateurs implantables › Radiotherapy-induced malfunctions of cardiac...
questionsmedicales.fr › Tumeurs › Radiotherapy-induced malfunctions of cardiac...