Abstract Radiotherapy can affect the electronic components of a cardiac implantable electronic device (CIED) resulting in malfunction and/or damage. We sought to assess the incidence, predictors and ...clinical impact of CIED dysfunction (CIED-D) following radiotherapy for cancer treatment. Clinical characteristics, cancer and different types of CIEDs as well as radiation-dose were evaluated. The investigation identified 230 patients; mean age 78±8 years and 70% were male. A total of 199 (86%) patients had pacemakers (59% dual-chamber), 21 (9%) cardioverter-defibrillators and 10 (4%) resynchronizators/defibrillators. The left pectoral (n=192, 83%) was the most common CIED location. Sixteen (7%) patients experienced 18 events of CIED-D after radiotherapy. Reset to back-up pacing mode was the most common encountered dysfunction, and only 1 (6%) patient of those with CIED-D experienced symptoms of atrio-ventricular dys-synchrony. Those who had CIED-D had a shorter device-age at the time of radiotherapy compared to those who did not (2.5±1.5 vs. 3.8±3.4 years, P =0.005). The total dose prescribed to the tumor (66±30 vs. 42±23 Gy) was significantly higher among those who had CIED-D (P<0.0001). Multivariable logistic regression analysis identified the total dose prescribed to the tumor as the only independent predictor for CIED-D (odds ratio: 1.19 for each increase in 5 Gy, 95% confidence interval: 1.08-1.31, P=0.0005). In conclusion, in this large population of patients with CIEDs undergoing radiotherapy for cancer treatment, the occurrence of newly diagnosed CIED-D was 7%, and the reset to back-up pacing mode was the most common encountered dysfunction. The total dose prescribed to the tumor was a predictor of CIED-D. Importantly, although the unpredictability of CIEDs under radiotherapy is still an issue, none of our patients experienced significant symptoms, life-threatening arrhythmias or conduction disorders.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract Background The duration of red blood cell (RBC) storage may have a negative impact on endothelial nitric oxide bioavailability. We tested the hypothesis that transfused fresh blood will have ...a more favourable effect on microvascular endothelial function as compared to older standard issue blood. Methods Participants requiring chronic RBC transfusions were enrolled in a crossover-design study to receive fresh (less than 7 days storage) or standard (up to 42 days storage) blood on two separate visits. Endothelial function was assessed by Reactive Hyperaemia Peripheral Arterial Tonometry (Rh-PAT) that was measured prior to and following transfusions. For each participant, the difference between endothelial function pre and post transfusion was assessed in relation to blood storage time. Results Twenty one patients (71 ± 16 years, 52% females) were enrolled. Mean age of fresh blood was 5.5 days ±1.0 and of standard blood was 24.5 days ±7.9 days. The pre-transfusion haemoglobin was 83.1 ± 2.5 g/L and post-transfusion 98.9 ± 2.6 g/L. An average of 2 units of packed Red Blood Cells ( pRBCs) were transfused. Microvascular endothelial function decreased more frequently after transfusion of standard blood compared to fresh blood. Standard issue blood transfusion was associated with decrease in Rh-PAT index (−0.25 ± 0.63) compared to fresh blood (+0.03 ± 0.49), P = .026. Conclusion Transfusions of standard issue blood is associated with less favourable effect on microvascular endothelial function as compared to fresh blood.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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