Xu Beizheng, Wang Yueying, Tse Gary, Chen Jiayi, Li Guangping, Korantzopoulos Panagiotis, Liu Tong
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, Hong Kong; Kent and Medway Medical School, Canterbury, Kent, United Kingdom; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
Heart Rhythm. 2023 May;20(5):689-698. doi: 10.1016/j.hrthm.2023.01.024. Epub 2023 Jan 25.
Radiation therapy (RT) may pose acute and long-term risks for patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs).
We conducted a systematic review and meta-analysis to examine the association between RT and PM/ICD malfunctions in patients with cancer.
We searched the literature using the PubMed, the Cochrane Library the Web of Science, and Embase for relative publications until April 2022. Of the 550 initially identified studies, 17 retrospective observational studies including 2454 patients were finally analyzed.
The meta-analysis showed that RT was associated with an increased risk of ICD malfunctions (odds ratio [OR] 2.75; 95% confidence interval [CI] 1.74-4.33). Five studies were included in the subgroup analysis regarding photon beam energy, showing that radiation-induced CIED failure was more likely to occur in ICDs when beam energy was ≥10 MV (OR 5.28; 95% CI 2.14-13.03). Neutron-generating RT significantly increased the risk of CIED malfunctions (OR 3.97; 95% CI 1.70-9.26), especially the risk of reset (OR 5.79; 95% CI 2.37-14.12; P = .0001). We did not find significant differences in the risk of CIED failure between chest RT and other RT sites (OR 1.09; 95% CI 0.63-1.88).
Our meta-analysis suggests that ICDs are more likely to be affected by RT than PMs. These adverse events, especially reset, in patients with cancer were associated with neutron-generating RT and beam energy ≥10 MV. Given the increasing requirement for RT in several patients with cancer as well as the increasing implantation rates of CIEDs, a better risk stratification is needed in this setting.
放射治疗（RT）可能会给心脏植入式电子设备（CIED）患者带来急性和长期风险，这些设备包括起搏器（PM）和植入式心脏复律除颤器（ICD）。
我们进行了一项系统评价和荟萃分析，以研究RT与癌症患者PM/ICD故障之间的关联。
我们使用PubMed、Cochrane图书馆、科学网和Embase检索文献，以获取截至2022年4月的相关出版物。在最初确定的550项研究中，最终分析了17项回顾性观察性研究，共2454例患者。
荟萃分析表明，RT与ICD故障风险增加相关（比值比[OR]2.75；95%置信区间[CI]1.74-4.33）。五项研究纳入了关于光子束能量的亚组分析，结果显示当束能量≥10 MV时，放射诱导的CIED故障在ICD中更易发生（OR 5.28；95%CI 2.14-13.03）。产生中子的RT显著增加了CIED故障风险（OR 3.97；95%CI 1.70-9.26），尤其是重置风险（OR 5.79；95%CI 2.37-14.12；P = 0.0001）。我们未发现胸部RT与其他RT部位之间CIED故障风险存在显著差异（OR 1.09；95%CI 0.63-1.88）。
我们的荟萃分析表明，ICD比PM更易受RT影响。癌症患者中的这些不良事件，尤其是重置，与产生中子的RT和束能量≥10 MV相关。鉴于癌症患者对RT的需求不断增加以及CIED植入率不断上升，在此情况下需要更好的风险分层。
