In recent years, the number of cancer patients with cardiac implantable electronic devices (CIEDs) undergoing
radiotherapy has been increasing with prolonged life expectancy and the aging population.
Ionizing radiation, electromagnetic interference, and scattered radiation can cause permanent damages
or temporary malfunctions on such devices. Appropriate management of patients with CIEDs undergoing
radiotherapy is more challenging due to recent developments in radiation therapy techniques,
image guidance methods, and device technology. The effects of radiation on devices depend on the
model of the cardiac devices, clinical condition, and pacing dependency of the patient, cumulative dose
to device and the treatment parameters such as beam energy, beam modality, total dose, dose rate, scattered
radiation, radiotherapy fields, and imaging modality. A close collaboration among the radiation
oncologist, medical physicist, patients" cardiologist, device technologist, radiation therapist, and nurse is
crucial before, during, and after the radiotherapy sessions. Clinical guidelines and consensus of experts
have been published regarding the management of patients with devices undergoing radiotherapy. We
reviewed these guidelines and the literature on this issue and present recommendations for safer and
more successful radiotherapy of patients with cardiac implanted electronic devices.
Keywords: Implantable cardiac pacemakers; implantable cardioverter-defibrillators; patient management; radiotherapy
