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Background: Little data are available about radiation exposure during cardiac electrical device implantation, and no dose reference levels have been published. This multicenter, prospective, observational study assesses patient and staff radiation exposure during cardiac device implantations, and aims at defining dose reference levels. Methods: Patient demographic, procedural, and radiation data were obtained for 657 procedures from nine institutions. Physician and staff exposure were measured using real‐time dosimeters worn beneath and above lead apron. Statistical analysis included fluoroscopy time (FT), dose‐area product (DAP), and DAP adjusted for FT and body mass index. Results: Pacemakers and cardioverter defibrillators were implanted in 481 and 176 patients, respectively. Of these, 152 were treated with cardiac resynchronization therapy (CRT). Median FTs were 837s (interquartile range [IQR]: 480‐1323), 117s (IQR: 69‐209), and 101s (IQR: 58‐162), and median DAPs were 1410 (IQR: 807‐2601), 150 (IQR: 72‐338), and 129 (IQR: 72‐332) cGy.cm² for biventricular, dual chamber, and ventricular device implantation, respectively. Dose reference levels correspond to the third quartile values. During CRT, higher exposure was observed with four X‐ray systems than with the two newer and customizable ones (adjusted DAP of 0.90 [IQR: 0.26‐1.01] and 0.29 [IQR: 0.23‐0.39], respectively; P <.001). Conclusion: Based on real‐life measurements, this multicenter registry provides dose reference levels and may help centers assess radiation exposure. Although biventricular device implantation was responsible for the highest radiation exposure, FT was meaningfully shortened compared to previously reported values. For a same FT, the use of new generators and custom settings has significantly reduced DAP. [ABSTRACT FROM AUTHOR]

Background: Increasing numbers of patients with cardiac implantable electronic devices (CIEDs) are undergoing radiotherapy (RT) for cancer. The aim of the study was to prospectively evaluate the incidence, characteristics, and associated factors of CIED dysfunctions related to RT. Methods: Between April 2013 and March 2020, all patients with a CIED who underwent ≥1 RT session were enrolled. Patients were monitored according to a systematic protocol, including device interrogation before the first and after each RT session. The primary endpoint was CIED dysfunction, defined as oversensing, total or partial deprogramming, and/or unrecoverable reset. Results: We included a total of 92 CIED RT courses: 77 (83.7%) in patients with a pacemaker and 15 (16.3%) in those with an implantable cardioverter‐defibrillator. Overall, 13 dysfunctions (14.1%) were observed during 92 courses (1509 sessions), giving an incidence of 0.9 per 100 sessions. These included nine deprogramming (three total resets to back‐up pacing mode and six partial deprogramming that were all successfully reprogrammed), three transient oversensing, and one unrecoverable oversensing requiring CIED and leads replacement. There were no adverse clinical events related to device dysfunction. In multivariable analysis, neutron‐producing irradiation (odds ratio [OR], 5.59; 95% confidence interval [CI], 1.09–28.65; p =.039) and cumulative tumor dose (OR, 1.05; 95% CI, 1.01–1.10; p =.007) remained significantly associated with CIED dysfunction. Conclusion: In this prospective study, transient or permanent subclinical CIED dysfunction occurred in 14.1% of RT courses. Our findings emphasize the importance of high‐energy beams and neutron‐producing irradiation in risk assessment. [ABSTRACT FROM AUTHOR]