Impact of different radiation techniques and doses on cardiac implantable electronic devices

Background and objectivePurpose of this investigation was to get deeper insight into the impact of different radiation techniques and doses on cardiac implantable electric devices (CIEDs). We aimed to mimic a worst-case scenario with very high doses and external radiation being applied directly on the devices.MethodsRadiation was applied on 21 CIEDs as photon or electron therapy with maximum dose of 150 Gy in fractions of 2 -20 Gy. CIEDS were put directly into the beam. Brachytherapy was applied with doses of 6 Gy to a maximum of 42 Gy. Check-ups took place after every fraction and one week after radiation. We calculated the estimated potential risk for the health and survival of patients as well as the risk for CIEDs’ loss of function.Results28 life- or health-threatening errors occurred during photon therapy, 3/7 devices showed complete loss of function. During electron therapy, 31 potentially patient-threatening errors and 2 losses of function were detected. During brachytherapy, none of the devices showed loss of function but 8 patient-threatening errors occurred. Inadequate shock releases were mostly seen after photon and brachytherapy, random noises occurred more often during electron therapy. The earliest potentially serious error occurred during after 2 Gy photon radiation and 6 Gy brachytherapy. Losses of function occurred earliest at 80 Gy.ConclusionThe results underline the warning for precaution concerning CIED patients derived from recommendations in the literature. Our study offers new information especially about the impact of electron radiation and brachytherapy on CIEDs. Risk for the devices to for loss of telemetry or battery capacity might be negligible with normafractionated therapy.