

La radiothérapie (RT) peut compromettre la fonction des dispositifs électroniques cardiaques implantables (CIED) à type de stimulateurs cardiaques (PM) ou de défibrillateurs automatiques implantables (DAI) et mettre ainsi en jeu le pronostic vital de ces patients.
La prise en charge de ces patients constitue un défi pratique et procédural et nécessite une approche multidisciplinaire structurée.
Ce document de consensus est rédigé par un groupe de travail multidisciplinaire impliquant des électro- physiologistes cardiaques, des radiothérapeutes et des physiciens médicaux.
Il a pour objectif d’établir des recommandations sur la stratification des risques et sur les mesures /précautions à prendre avant, pendant et après les séances de radiothérapie chez les patients porteurs de CIED pour prévenir les dysfonctions des CIED associées à l'irradiation.
- 1. Mond HG, Irwin M, Ector H, Proclemer A. The world survey of cardiac pacing and cardioverter-defibrillators: calendar year 2005 an International Cardiac Pacing and Electrophysiology Society (ICPES) project. Pacing Clin Electrophysiol. 2008;31:1202–1212. 2. Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC) Developed in collaboration with the European Heart Rhythm Association (EHRA) Eur Heart J. 2013;34:2281–2329. 3. Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 2005 Sep 15;104(6):1129-37. 4. Miften M, Mihailidis D, Kry SF et al. Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A report of the AAPM TG-203. Med Phys 2019;46:e757–e88 5. Bernstein AD, Daubert JC, Fletcher RD, Hayes DL, Lüderitz B, Reynolds DW, Schoenfeld MH, Sutton R. The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. Pacing Clin Electrophysiol. 2002 Feb;25(2):260-4. 6. Bitterman DS, Zei PC, Mak RH. Radiation Safety and Cardiovascular Implantable Electronic Devices Int J Radiat Oncol Biol Phys 2018 Oct 1;102(2):243-246. 7. Yeung C, Chacko S, Glover B, Campbell D, Crystal E, Ben-Dov N, Baranchuk A, Radiotherapy for Patients with Cardiovascular Implantable Electronic Devices: A Review, Can J Cardiol. 2018;34(3):244-251 8. Indik JH, Gimbel JR, Abe H, Alkmim-Teixeira R, Birgersdotter- Green U, Clarke GD, et al. 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm. 2017; 14(7):e97–e153. 9. Brambatti M, Mathew R, Strang B, et al. Management of patients with implantable cardioverter-defibrillators and pacemakers who require radiation therapy. Heart Rhythm 2015;12(10):2148–2154. 10. Grant JD, Jensen GL, Tang C, et al. Radiotherapy-induced malfunction in contemporary cardiovascular implantable electronic devices: clinical incidence and predictors. JAMA Oncol 2015;1(5):624–632. 105. 11. Makkar A, Prisciandaro J, Agarwal S, et al. Effect of radiation therapy on permanent pacemaker and implantable cardioverter-defibrillator function. Heart Rhythm 2012;9(12):1964–1968. 12. Zaremba T, Jakobsen AR, Sogaard M, et al. Risk of device malfunction in cancer patients with implantable cardiac device undergoing radiotherapy: a populationbased cohort study. Pacing Clin Electrophysiol 2015;38(3):343–356. 13. Kazuhiko Nakamura, Takahiro Aoyama, Naoki Kaneda, Masashi Otsuji, Yoshitaka Minami, Ami Sakuragi, Masaru Nakamura. Effect of X-ray dose rates higher than 8 Gy/min on the functioning of cardiac implantable electronic devices. J Radiat Res. 2020 May; 61(3): 419–425. 14. Ohno T, Soejima T, Sekiguchi Y, Hashimoto T, Koike I, Matsubara H, et al. JASTRO/JCS Guidelines for radiotherapy in patients with cardiac implantable electronic devices. J Radiat R. 2021;62(1):172–184. 15. Michael Glikson, Jens Cosedis Nielsen, Mads Brix Kronborg, Yoav Michowitz, Angelo Auricchio. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: supplementary data. European Heart Journal. 202 ; 00, 1-32 16. Huertas A, Thuillot M, Bibault J-E, Sharifzadehgan Laurans A, Giraud P, et al. Prise en charge des patients porteurs de stimulateurs cardiaques ou défibrillateurs automatiques implantables traités par irradiation. Cancer Radiother (2018). 17. Zecchin M, Severgnini M, Fiorentino A, Malavasi VL, Menegotti L, Alongi F, et al. Management of patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy: A consensus document from Associazione Italiana Aritmologia e Cardiostimolazione (AIAC), Associazione Italiana Radioterapia Oncologica (AIRO), Associazione Italiana Fisica Medica (AIFM). Int J Cardiol. 2018; 255:175-183. 18. Grant JD, Jensen GL, Tang C, Pollard JM, Kry SF, Krishnan S, et al. Radiotherapy-induced malfunction in contemporary cardiovascular implantable electronic devices: clinical incidence and predictors. JAMA Oncol. 2015;1(5):624–32. 19. Gossman MS, Wilkinson JD, Mallick A. Treatment approach, delivery, and follow-up evaluation for cardiac rhythm disease management patients receiving radiation therapy: retrospective physician surveys including chart reviews at numerous centers. Med Dosim. 2014;39(4):320–4. 20. SungW, Kim S, Kim JI, Lee JG, Shin YJ, Jung JY, et al. Dosimetric perturbations due to an implanted cardiac pacemaker in MammoSite((R)) treatment. Med Phys. 2012;39(10):6185–91. 21. Peet SC,Wilks R, Kairn T, Crowe SB. Measuring dose from radiotherapytreatments in the vicinity of a cardiac pacemaker. Phys Med. 2016;32(12):1529–36. 22. Wadasadawala T, Pandey A, Agarwal JP, Jalali R, Laskar SG, Chowdhary S, et al. Radiation therapy with implanted cardiac pacemaker devices: a clinical and dosimetric analysis of patients and proposed precautions. Clin Oncol (R Coll Radiol). 2011;23(2):79–85. 23. Makkar A, Prisciandaro J, Agarwal S, Lusk M, Horwood L,Moran J, et al. Effect of radiation therapy on permanent pacemaker and implantable cardioverter-defibrillator function. Heart Rhythm. 2012;9(12):1964–8. 24. Munshi A, Agarwal JP, Pandey KC. Cancer patients with cardiac pacemakers needing radiation treatment: a systematic review. J Cancer Res Ther. 2013;9(2):193–8. 25. Gauter-Fleckenstein B, Israel CW, Dorenkamp M, Dunst J, Roser M, Schimpf R,et al. DEGRO/DGK guideline for radiotherapy in patients with cardiac implantable electronic devices. Strahlenther Onkol Organ Dtsch RontgengesellschaftAl 2015;191:393–404. 26. Barillot I, Mazeron R, Mornex F, Giraud P. Patients porteurs d’un stimulateur cardiaque ou d’un défibrillateur implantable. Cancer Radiother2016;20:S256–8. 27. Sharifzadehgan A , Laurans M, Thuillot M , Huertas A, Baudinaud P, Mirabel M, Bibault JE, et al. Radiotherapy in Patients with a Cardiac Implantable Electronic Device. Am J Cardiol. 2020;128:196-201.














