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photon beam energy.827,829 For patients receiving electron or kV photon beam RT, CIED evaluation appears largely unnecessary.827 For patients treated with proton beam RT, special consideration should be paid to the neutron component of the beam, as the risk of CIED reset is potentially significant.824,830 The CIED should be rechecked within 2 weeks of completion of RT treatment. Systematic remote CIED monitoring may be helpful to optimize the patient’s surveillance.831

L o w-risk patient s High-risk patients

L o w-risk patient s High-risk patients High-risk patients

R T type and dose R R

Pacing-dependent

CIED evaluation: CIED evaluation: CIED evaluation: CIED evaluation: Be f o

f f r e R T

R R a (Class I)

Audio-visual monitoring Be f o

f f r e R T

R R a

W eek W W l y during R T

R R

ECG and/or pulse o ximet r y monitoring and external pacing a vailable

a a

during R T sessions

R R Be f o

f f r e R T

R R a

W eek W W l y during R T

R R

ECG and/or pulse o ximet r y monitoring and external pacing a vailable

a a

during R T sessions

R R

Be f o

f f r e R T

R R a (Class I)

Audio-visual monitoring

CIED check-up after completing radiother a p y

p

(Class I)

(Class I) (Class I)

Pacing-dependent or f r equent ICD ther a pies

Neut r on-generating R T

R R

or dose ≥ 2 Gy

<10 MV photons or

2–9 Gy ≥ 10 MV photons or

≥ 10 Gy

Non-neut r on-generating R T

R R

or dose <2 Gy

Management of patients with CIED located outside the R T t

R R r eatment v olume

N N

Y Y

Figure 46 Management of patients with a cardiac implantable electronic device located outside the radiotherapy treatment volume. CIED, cardiac implantable electronic device; ECG, electrocardiogram; Gy, Gray; ICD, implantable cardioverter defibrillator; MV, megavolt; N, no; RT, radiotherapy; Y, yes. aIf last CIED check .3 months earlier. Downloaded from academic.oup.com/eurheartj/article/43/41/4229/6673995 by guest on 07 October 2026