Approach to cardio-oncologic patients with special focus on patients with cardiac implantable electronic devices planned for radiotherapy: results of the European Heart Rhythm Association survey

The number of patients with cardiac implantable electronic devices (CIED), who require oncological management including radiotherapy (RT) is still increasing. According to current knowledge the most frequent device dysfunction related to exposition to ionizing radiation is reprogramming to emergency mode (soft reset). There are uncommon cases of complete, irreversible device damage. CIED dysfunction during RT can be observed in approximately 3% of patients. In majority of cases they are asymptomatic, although in literature there are descriptions of deterioration of clinical status due to bradycardia or exacerbation of heart failure. The most important factor of device malfunction is radiotherapy with photons of energy >10 MV or protons despite energy used. So far there were no cases published with inadequate ICD therapies due to the presence of electromagnetic field interference during RT. Because patients with CIED undergoing RT need complex care to achieve high level of safety, experts of Heart Rhythm Society establish document, published in 2017 which summarized current knowledge about this group of patients. The document contains guidelines on peri-radiotherapy care of patients with CIED.

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Lead-Related Infective Endocarditis in Latvia: A Single Centre Experience

Medicina ◽

10.3390/medicina55090566 ◽

2019 ◽

Vol 55 (9) ◽

pp. 566

Author(s):

Nesterovics ◽

Stradins ◽

Kalejs ◽

Ansabergs ◽

...

Keyword(s):

Infective Endocarditis ◽

Electronic Devices ◽

Positive Culture ◽

Major Complication ◽

Heart Rhythm ◽

University Hospital ◽

Lead Extraction ◽

Coagulase Negative Staphylococci ◽

Cardiac Implantable Electronic Devices ◽

Common Location

Background and Objectives: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE. Materials and Methods: The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records. Results: Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5–73.0) years, median hospital stay was 15.5 (22.0–30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were Staphylococcus aureus (23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease. Conclusions: Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.

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Remote monitoring of cardiac implantable electronic devices in Europe: results of the European Heart Rhythm Association survey

EP Europace ◽

10.1093/europace/eut414 ◽

2013 ◽

Vol 16 (1) ◽

pp. 129-132 ◽

Cited By ~ 30

Author(s):

A. Hernandez-Madrid ◽

T. Lewalter ◽

A. Proclemer ◽

L. Pison ◽

G. Y. H. Lip ◽

...

Keyword(s):

Remote Monitoring ◽

Electronic Devices ◽

Heart Rhythm ◽

Cardiac Implantable Electronic Devices

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Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 Report from the European Heart Rhythm Association

EP Europace ◽

10.1093/europace/euw244 ◽

2016 ◽

Vol 18 (suppl 3) ◽

pp. iii1-iii79 ◽

Cited By ~ 36

Author(s):

M.J. Pekka Raatikainen ◽

David O. Arnar ◽

Bela Merkely ◽

A. John Camm ◽

Gerhard Hindricks

Keyword(s):

European Society ◽

Electronic Devices ◽

Heart Rhythm ◽

Clinical Use ◽

Cardiac Implantable Electronic Devices ◽

Electrophysiological Procedures ◽

European Society Of Cardiology

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Canadian Heart Rhythm Society and Canadian Association of Radiologists Consensus Statement on Magnetic Resonance Imaging with Cardiac Implantable Electronic Devices

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2014.08.001 ◽

2014 ◽

Vol 65 (4) ◽

pp. 290-300 ◽

Cited By ~ 11

Author(s):

Atul Verma ◽

Andrew C.T. Ha ◽

Carole Dennie ◽

Vidal Essebag ◽

Derek V. Exner ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Electronic Devices ◽

Heart Rhythm ◽

Resonance Imaging ◽

Cardiac Implantable Electronic Devices ◽

Canadian Association ◽

Mri Environment ◽

Magnetic Resonance Imaging Mri ◽

Mri Conditional

Magnetic resonance imaging (MRI) has historically been considered contraindicated for individuals with cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable defibrillators. Magnetic resonance scanners produce magnetic fields that can interact negatively with the metallic components of CIEDs. However, as CIED technology has advanced, newer MRI conditional devices have been developed that are now in clinical use and these systems have had demonstrated safety in the MRI environment. Despite the supportive data of such CIED systems, physicians remain reluctant to perform MRI scanning of conditional devices. This joint statement by the Canadian Heart Rhythm Society and the Canadian Association of Radiologists describes a collaborative process by which CIED specialists and clinics can work with radiology departments and specialists to safely perform MRI in patients with MRI conditional CIED systems. The steps required for patient and scanning preparation and the roles and responsibilities of the CIED and radiology departments are outlined. We also briefly outline the risks and a process by which patients with nonconditional CIEDs might also receive MRI in highly specialized centres. This document supports MRI in patients with MRI conditional CIEDs and offers recommendations on how this can be implemented safely and effectively.

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