{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:07:55Z","timestamp":1791828475236,"version":"4.3.4"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005713","name":"Technische Universit\u00e4t M\u00fcnchen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005713","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Strahlenther Onkol"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>Increasing life expectancy and advances in cancer treatment will lead to more patients needing both radiation therapy (RT) and cardiac implantable electronic devices (CIEDs). CIEDs, including pacemakers and defibrillators, are essential for managing cardiac arrhythmias and heart failure. Telemetric monitoring of CIEDs checks battery status, lead function, settings, and diagnostic data, thereby identifying software deviations or damage. This study evaluates the German Society for Radiation Oncology (DEGRO)\/German Society for Cardiology (DGK) guideline, assessing real-world complications and risk factors and analyzing pacemaker and implantable cardioverter-defibrillator (ICD) lead function for their predictive value concerning device malfunction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A\u00a0total of 54\u00a0patients with pacemakers or ICDs who underwent radiation therapy were identified. Demographics, treatment courses, and device information from physical and digital records were extracted. DEGRO\/DGK risk groups and pacemaker dependency at the start of RT were assessed. Delineation of the devices and lead insertion sites was performed in the treatment planning system. Dosimetric information from the treatment plans was then correlated with reports of standardized device checks.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Over 80% of patients were treated with dual-chamber pacemakers or cardiac resynchronization therapy (CRT), and 16.7% had ICDs. One third of patients were pacemaker dependent. 59.3% of patients were in the low-risk category, 29.3% in the medium-risk, and 11.1% in the high-risk category. Thoracic irradiation resulted in the highest median dose to devices. Lead parameter deviations exceeding thresholds were found in 14.8% for the stimulation threshold and 13.5% for sensing. Device malfunctions occurred in 3.7% of cases, both involving electrical resets and neutron-producing radiation (beam energy 10\u00a0megaelectron volt (MV) or higher).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Collecting lead parameters in addition to secure malfunctions like electrical restarts and memory erasure revealed a\u00a0significant proportion of treatment courses with temporary changes, though no correlation with individual treatment plans or adverse events was found. The focus on reducing neutron-producing radiation could be further supported.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00066-024-02345-0","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T14:28:55Z","timestamp":1736519335000},"page":"463-471","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Influence of radiotherapy on cardiac implantable devices and leads\u2014a\u00a0single-institution analysis and critical evaluation of current guidelines"],"prefix":"10.1007","volume":"201","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8574-9444","authenticated-orcid":false,"given":"Jakob","family":"Warmbrunn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Straube","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Ulrich","family":"Haase","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Sinnecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Ludwig","family":"Laugwitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie E.","family":"Combs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Habermehl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,10]]},"reference":[{"key":"2345_CR1","first-page":"1","volume-title":"Lebenserwartung in","author":"G Doblhammer","year":"2008","unstructured":"Doblhammer\u00a0G, Muth\u00a0E, Kruse\u00a0A (2008) Lebenserwartung in Deutschland. Trends, Prognose, Risikofaktoren und der Einfluss ausgew\u00e4hlter Medizininnovationen, Deutschland, pp\u00a01\u2013150"},{"issue":"10","key":"2345_CR2","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1007\/s00392-005-0269-3","volume":"94","author":"B Lemke","year":"2005","unstructured":"Lemke\u00a0B, Nowak\u00a0B, Pfeiffer\u00a0D (2005) Leitlinien zur Herzschrittmachertherapie. Zeitschrift f\u00fcr Kardiologie 94(10):704\u2013720","journal-title":"ZS Kardiologie"},{"issue":"8","key":"2345_CR3","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1056\/NEJMoa1603265","volume":"376","author":"RJ Russo","year":"2017","unstructured":"Russo\u00a0RJ et\u00a0al (2017) Assessing the Risks Associated with MRI in Patients with a\u00a0Pacemaker or Defibrillator. N\u00a0Engl J Med 376(8):755\u2013764","journal-title":"N Engl J Med"},{"issue":"4","key":"2345_CR4","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3892\/mco.2024.2764","volume":"21","author":"Y Liang","year":"2024","unstructured":"Liang\u00a0Y et\u00a0al (2024) The impact of metal implants on the dose and clinical outcome of radiotherapy (Review). Mol Clin Oncol 21(4):66","journal-title":"Mol Clin Oncol"},{"issue":"3","key":"2345_CR5","first-page":"583","volume":"18","author":"LK Liu","year":"2017","unstructured":"Liu\u00a0LK et\u00a0al (2017) Pathogenesis and Prevention of Radiation-induced Myocardial Fibrosis. Asian Pac J Cancer Prev 18(3):583\u2013587","journal-title":"Asian Pac J Cancer Prev"},{"key":"2345_CR6","doi-asserted-by":"crossref","first-page":"389","DOI":"10.3389\/fphys.2016.00389","volume":"7","author":"G Amoros-Figueras","year":"2016","unstructured":"Amoros-Figueras\u00a0G et\u00a0al (2016) Recognition of Fibrotic Infarct Density by the Pattern of Local Systolic-Diastolic Myocardial Electrical Impedance. Front Physiol 7:389","journal-title":"Front Physiol"},{"issue":"5","key":"2345_CR7","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/s00066-015-0817-3","volume":"191","author":"B Gauter-Fleckenstein","year":"2015","unstructured":"Gauter-Fleckenstein\u00a0B et\u00a0al (2015) DEGRO\/DGK guideline for radiotherapy in patients with cardiac implantable electronic devices. Strahlenther Onkol 191(5):393\u2013404","journal-title":"Strahlenther Onkol"},{"issue":"8","key":"2345_CR8","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1001\/jama.2009.205","volume":"301","author":"P Tricoci","year":"2009","unstructured":"Tricoci\u00a0P et\u00a0al (2009) Scientific evidence underlying the ACC\/AHA clinical practice guidelines. JAMA 301(8):831\u2013841","journal-title":"JAMA"},{"issue":"1","key":"2345_CR9","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.canrad.2021.11.003","volume":"26","author":"A Escande","year":"2022","unstructured":"Escande\u00a0A et\u00a0al (2022) Radiotherapy for patient with cardiac implantable electronic device, consensus from French radiation oncology society. Cancer Radiother 26(1):404\u2013410","journal-title":"Cancer Radiother"},{"issue":"e13862","key":"2345_CR10","first-page":"1","volume":"53","author":"VL Malavasi","year":"2023","unstructured":"Malavasi\u00a0VL et\u00a0al (2023) A\u00a0systematic review and meta-analysis on oncological radiotherapy in patients with a\u00a0cardiac implantable electronic device: Prevalence and predictors of device malfunction in 3121 patients. Eur J Clin Invest 53(e13862):1","journal-title":"Eur J Clin Invest"},{"issue":"16","key":"2345_CR11","doi-asserted-by":"crossref","first-page":"2879","DOI":"10.1088\/0031-9155\/47\/16\/304","volume":"47","author":"J Mouton","year":"2002","unstructured":"Mouton\u00a0J et\u00a0al (2002) Influence of high-energy photon beam irradiation on pacemaker operation. Phys Med Biol 47(16):2879\u20132893","journal-title":"Phys Med Biol"},{"issue":"1","key":"2345_CR12","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.radonc.2005.06.011","volume":"76","author":"CW Hurkmans","year":"2005","unstructured":"Hurkmans\u00a0CW et\u00a0al (2005) Influence of radiotherapy on the latest generation of pacemakers. Radiother Oncol 76(1):93\u201398","journal-title":"Radiother Oncol"},{"issue":"1","key":"2345_CR13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/j.1754-9485.2010.02138.x","volume":"54","author":"F Hudson","year":"2010","unstructured":"Hudson\u00a0F et\u00a0al (2010) Effect of radiation therapy on the latest generation of pacemakers and implantable cardioverter defibrillators: A\u00a0systematic review. J\u00a0Med Imaging Radiat Oncol 54(1):53\u201361","journal-title":"J Med Imaging Radiat Oncol"},{"issue":"5","key":"2345_CR14","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1001\/jamaoncol.2015.1787","volume":"1","author":"JD Grant","year":"2015","unstructured":"Grant\u00a0JD et\u00a0al (2015) Radiotherapy-Induced Malfunction in Contemporary Cardiovascular Implantable Electronic Devices. JAMA Oncol 1(5):624\u2013632","journal-title":"JAMA Oncol"},{"issue":"7","key":"2345_CR15","doi-asserted-by":"crossref","first-page":"e97","DOI":"10.1016\/j.hrthm.2017.04.025","volume":"14","author":"JH Indik","year":"2017","unstructured":"Indik\u00a0JH et\u00a0al (2017) 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm 14(7):e97\u2013e153","journal-title":"Heart Rhythm"},{"key":"2345_CR16","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.ijcard.2017.12.061","volume":"255","author":"M Zecchin","year":"2018","unstructured":"Zecchin\u00a0M et\u00a0al (2018) Management of patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy. Int J Cardiol 255:175\u2013183","journal-title":"Int J Cardiol"},{"issue":"41","key":"2345_CR17","doi-asserted-by":"crossref","first-page":"4229","DOI":"10.1093\/eurheartj\/ehac244","volume":"43","author":"AR Lyon","year":"2022","unstructured":"Lyon\u00a0AR et\u00a0al (2022) 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart\u00a0J 43(41):4229\u20134361","journal-title":"Eur Heart J"},{"key":"2345_CR18","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.radonc.2020.01.006","volume":"152","author":"B Gauter-Fleckenstein","year":"2020","unstructured":"Gauter-Fleckenstein\u00a0B et\u00a0al (2020) Effectivity and applicability of the German DEGRO\/DGK-guideline for radiotherapy in CIED-bearing patients. Radiother Oncol 152:208\u2013215","journal-title":"Radiother Oncol"},{"issue":"3","key":"2345_CR19","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1111\/pace.12572","volume":"38","author":"T Zaremba","year":"2015","unstructured":"Zaremba\u00a0T et\u00a0al (2015) Risk of device malfunction in cancer patients with implantable cardiac device undergoing radiotherapy: a\u00a0population-based cohort study. Pacing Clin Electrophysiol 38(3):343\u2013356","journal-title":"Pacing Clin Electrophysiol"},{"key":"2345_CR20","doi-asserted-by":"crossref","unstructured":"Miften M et al (2019) Management of Radiotherapy Patients with Implanted Cardiac Pacemakers and Defibrillators: A Report of the AAPM TG-203. Med Phys 46(12):e757\u2013e788","DOI":"10.1002\/mp.13838"},{"issue":"9","key":"2345_CR21","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1111\/jce.13659","volume":"29","author":"K Bravo-Jaimes","year":"2018","unstructured":"Bravo-Jaimes\u00a0K et\u00a0al (2018) CIED malfunction in patients receiving radiation is a\u00a0rare event that could be detected by remote monitoring. J\u00a0Cardiovasc Electrophysiol 29(9):1268\u20131275","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2345_CR22","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.amjcard.2020.04.045","volume":"128","author":"A Sharifzadehgan","year":"2020","unstructured":"Sharifzadehgan\u00a0A et\u00a0al (2020) Radiotherapy in Patients With a\u00a0Cardiac Implantable Electronic Device. Am J Cardiol 128:196\u2013201","journal-title":"Am J Cardiol"}],"container-title":["Strahlentherapie und Onkologie"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-024-02345-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00066-024-02345-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-024-02345-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,22]],"date-time":"2025-03-22T23:19:44Z","timestamp":1742685584000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00066-024-02345-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,10]]},"references-count":22,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["2345"],"URL":"https:\/\/doi.org\/10.1007\/s00066-024-02345-0","relation":{},"ISSN":["0179-7158","1439-099X"],"issn-type":[{"value":"0179-7158","type":"print"},{"value":"1439-099X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,10]]},"assertion":[{"value":"2 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 December 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 January 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"J.\u00a0Warmbrunn, C.\u00a0Straube, H.U.\u00a0Haase, D.\u00a0Sinnecker, K.\u00a0Laugwitz, S.E.\u00a0Combs, S.\u00a0Schneider, and D.\u00a0Habermehl declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}