Multiple myeloma and a mischievous pacemaker: A teaching case involving irradiation of a cardiovascular implantable electronic device.

Cardiovascular implantable electronic devices (CIEDs) include implantable cardioverter defibrillators (ICDs) and implantable cardiac pacemakers (ICPs). [1] 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: 624-632 Crossref PubMed Scopus (72) Google Scholar ICDs generate a shock to correct lethal arrhythmias, whereas ICPs produce electrical stimuli to pace bradyarrhythmias. As the prevalence of cardiovascular disease rises, patients undergoing radiation therapy (RT) are more likely to have CIEDs [2] Munshi A Agarwal JP Pandey KC Cancer patients with cardiac pacemakers needing radiation treatment: A systematic review. J Cancer Res Ther. 2013; 9: 193-198 Crossref PubMed Scopus (20) Google Scholar and to be at risk for cardiovascular death. [3] Zaorsky NG Churilla TM Egleston BL et al. Causes of death among cancer patients. Ann Oncol. 2017; 28: 400-407 Abstract Full Text Full Text PDF PubMed Scopus (276) Google Scholar Limiting potential RT-induced CIED damage in our patients is therefore of increasing importance. We present a CIED-dependent patient who underwent RT to a tumor abutting his ICP and highlight considerations involved in palliative RT and CIED irradiation.