Treatment of patients with cardiac pacemakers and implantable cardioverter-defibrillators during radiotherapy

Purpose: To define the practical clinical guidelines that can be implemented by busy radiation oncology departments to minimize the risk of harm to patients with implanted cardiac pacemaker (ICP) and implantable cardioverter-defibrillator (ICD) devices during radiotherapy. Methods and Materials: A literature review was conducted to identify the mechanism of potential damage to ICPs and ICDs from exposure to electromagnetic interference and/or ionizing radiation and to assess the published evidence of such device malfunction or failure. Recommendations for patient management were obtained from three major manufacturers. Eighty-seven radiation oncology facilities across the United States and Canada were contacted to determine current practice patterns; 75 centers responded. Results: The published documentation of potential life-threatening malfunction of ICP and ICD devices exposed to electromagnetic interference and ionizing radiation is considerable. However, major discrepancies exist among manufacturer recommendations and wide variations are present among radiation oncology facilities regarding patient management precautions. Conclusion: Precautions are necessary to minimize the risk to patients with ICP and ICD devices during radiotherapy. Practical management guidelines are presented that can be readily adopted by any busy clinical radiation oncology practice. (C) 2004 Elsevier Inc.