A systematic review and meta-analysis on oncological radiotherapy in patients with a cardiac implantable electronic device: Prevalence and predictors of device malfunction in 3121 patients



Malavasi, Vincenzo Livio, Imberti, Jacopo Francesco, Tosetti, Alberto, Romiti, Giulio Francesco, Vitolo, Marco ORCID: 0000-0002-5196-6249, Zecchin, Massimo, Mazzeo, Ercole, Giuseppina, De Marco, Lohr, Frank, Lopez-Fernandez, Teresa
et al (show 1 more authors) (2023) A systematic review and meta-analysis on oncological radiotherapy in patients with a cardiac implantable electronic device: Prevalence and predictors of device malfunction in 3121 patients. EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, 53 (1). e13862-.

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Abstract

<h4>Background</h4>The number of patients with cardiac implantable electronic devices (CIEDs) undergoing radiotherapy (RT) for cancer treatment is growing. At present, prevalence and predictors of RT-induced CIEDs malfunctions are not defined.<h4>Methods</h4>Systematic review and meta-analysis conducted following the PRISMA recommendations. PubMed, Scopus and Google Scholar were searched from inception to 31/01/2022 for studies reporting RT-induced malfunctions in CIEDs patients. Aim was to assess the prevalence of RT-induced CIEDs malfunctions and identify potential predictors.<h4>Results</h4>Thirty-two out of 3962 records matched the inclusion criteria and were included in the meta-analysis. A total of 135 CIEDs malfunctions were detected among 3121 patients (6.6%, 95% confidence interval [CI]: 5.1%-8.4%). The pooled prevalence increased moving from pacemaker (PM) to implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy and defibrillator (CRT-D) groups (4.1%, 95% CI: 2.9-5.8; 8.2% 95% CI: 5.9-11.3; and 19.8%, 95% CI: 11.4-32.2 respectively). A higher risk ratio (RR) of malfunctions was found when neutron-producing energies were used as compared to non-neutron-producing energies (RR 9.98, 95% CI: 5.09-19.60) and in patients with ICD/CRT-D as compared to patients with PM/CRT-P (RR 2.07, 95% CI: 1.40-3.06). On the contrary, no association was found between maximal radiation dose at CIED >2 Gy and CIEDs malfunctions (RR 0.93; 95% CI: 0.31-2.76).<h4>Conclusions</h4>Radiotherapy related CIEDs malfunction had a prevalence ranging from 4% to 20%. The use of neutron-producing energies and more complex devices (ICD/CRT-D) were associated with higher risk of device malfunction, while the radiation dose at CIED did not significantly impact on the risk unless higher doses (>10 Gy) were used.

Item Type: Article
Uncontrolled Keywords: cancer, cardiac implantable electronic devices, implantable cardioverter defibrillator, pacemaker, radiation therapy, radiotherapy
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 15 May 2023 13:18
Last Modified: 15 May 2023 13:18
DOI: 10.1111/eci.13862
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3170382