Radiotherapy and implanted cardioverter defibrillators

A number of studies have reported an increase in radiation sensitivity of pacemakers or implantable cardioverter defibrillators. The type, severity and extent of radiation damage to these devices depend on the total dose and rate. We report the case of a 70-year-old male patient with non-small cell lung cancer presenting as a sub-carinal paraesophageal lesion, and a history of dilated cardiomyopathy and cardioverter-defibrillator implantation. The decision of a multidisciplinary meeting was to keep the device in place and deliver radiotherapy using an intensity-modulated radiation therapy technique by means of helical tomotherapy. The radiotherapy was well tolerated and consistent device interrogation revealed no malfunction. Innovative irradiation techniques have made radiotherapy feasible despite the presence of technological sophistications of pacemakers and cardioverter defibrillators that have potentially changed the tolerance profiles.