Radiotherapy and cardiac implantable electronic devices: a nurse-based protocol in a single centre experience

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: An increasing number of patients need cardiac implantable electronic devices (CIED) for bradycardia or to prevent sudden cardiac death. At the same time many patients require radiotherapy for oncologic reasons. Interaction between CIEDs and ionizing radiations may cause several dysfunctions: electromagnetic interferences due to oversensing, CIED reset, drainage of the battery, hardware damage to the pulse generator and to the lead-tissue interface. PURPOSE: An adequate planning is expected to guarantee the safety of CIED patients, reducing the potential complications. We describe our protocol in use and its application. METHODS: In 2016 an internal protocol was written to standardize the approach to CIED patients undergoing radiotherapy. Cardiology Department, Radiotherapy Unit and Medical Physics were involved in the draft. We stratified patients in high and low risk groups according to the CIED characteristics (ICD vs pacemaker), electro-dependency (yes vs no), and the estimated radiation dose (< 2 Gy: 2-10 Gy, > 10 Gy). Low risk group: - Non pacemaker (PM) dependent patients, estimated dose < 10 Gy - PM dependent patients, estimated dose < 2 Gy High risk group: - PM dependent patients, estimated dose > 2 Gy - Non-PM dependent patients estimated dose >10 Gy - ICD patients Two EHRA certificated nurses followed up the patients before, during and after the radiotherapy. Low risk patients received weekly in office evaluation during radiotherapy course. High risk patients were scheduled for daily in office check plus monitoring during each radiotherapy session, ICD therapy was temporarily switched off during each radiotherapy session. An in office evaluation was planned 1, 3, 6 and 12 months after the end of radiotherapy course until 2019, since 2020 all patients were given remote monitoring for accurate follow up. RESULTS: Between 2016 and November 2022 101 patients with CIED underwent radiotherapy in our facility. Clinical characteristics of the patients are described in Table 1. EHRA certificated nurses managed 1282 radiotherapy sessions without any complication. A transient underestimation of ICD longevity was the only software error occurred. CONCLUSIONS: The reported protocol assured a safe radiotherapy course for all our CIED patients. Given the limited data available about the interaction between the newest CIEDs and radiotherapy, we opted for a high safety profile. The EHRA certified nurse’s involvement allowed to optimize personnel resources. [Figure: see text]