Cardiovascular Implantable Electronic Devices -> Tachycardia Devices: -> Device Technology D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-038 - Electromagnetic Interferences On Wireless-enabled Pacemakers And Icds During Radiotherapy: A Multi-center, Real-time, In-vitro Observation (ID 1350)

Abstract

Background: High dose oncologic radiotherapy (RT) may affect normal function of pacemakers (PMs) or cardioverter-defibrillators (ICDs). Potentially life-threatening malfunctions may present in PM-dependent or ICD patients, and both manufacturers and guidelines discourage direct exposure.
Objective: To evaluate transient, electromagnetic-interferences (EMI)-related CIED malfunctions during direct exposure to doses up to 10 Gy, 18 PMs and 43 ICDs were evaluated in three different centers.
Methods: All CIEDs had baseline interrogation. Rate-adaptive function was disabled. In ICDs, antitachycardia therapies were disabled, with the detection windows for ventricular tachycardia (VT)/ventricular fibrillation (VF) still working. The CIEDs were randomized to receive either 2-, 5- or 10-Gy direct exposure by a 6-MV linear accelerator in a makeshift water phantom. During exposure, all the CIEDs were observed in a real-time session using manufacturer-specific programmers. Device function, such as pacing and sense issues, parameter settings, noise interferences, detections, was recorder by the video camera in the bunker throughout the entire exposure.
Results: During exposure, 14 PMs (23% overall; 77.8% among PMs) recorded minor EMI. Four PMs (6.6% overall; 22.2% among PMs) reported neither transient malfunction nor minor EMI. 40 ICDs (65.6% overall; 93% among ICDs) recorded major or minor transient EMI. For instance, 16 ICDs (26.2% overall; 37.2% among ICDs) reported EMI-related over-sense, pacing inhibition and VT/VF detections, while 24 ICDs (39.3% overall; 55.8% among ICDs) recorded minor EMI, and no detections were observed. Three ICDs (4.9% overall; 7% among ICDs) reported neither transient malfunction nor EMI. At immediate post-exposure interrogation, the ICDs that recorded major real-time malfunctions reported multiple VT/VF detections stored in the devices’ memories. Transient EMIs were observed regardless of either 2-, 5- or 10-Gy photon dose.
Conclusion: EMI-related sense issues were observed in the majority of our last-generation wireless-enabled CIEDs all through direct exposure. In high risk patients, magnet application on the CIED site or reprogramming to the asynchronous mode are still an issue to deal with during even 6-MV RT.
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