Background: During radiotherapy the pacemaker-patient is exceptionally endangered by ionising radiation, because a damaging impact on the pacemaker's circuit is possible.
Patients and methods: Guided by experiences of long standing dealing with pacemaker-patients during radiotherapy in our medical centre, we demonstrate possibilities to accompany these patients with well coordinated interdisciplinary co-operation. So the possible risks by ionising radiation can be identified and restricted. Our investigations on explanted pacemakers will explain the influence on programmable pacemaker systems. Standard values for the dose of 9-MV-photons will be recommended.
Results: The radiation dose, the pacemaker system is exposed during radiotherapy, should be kept as small as possible by suitable methods (e. g. shielding, selection of radiation quality, shifting of the pacemaker system to a region of less doses), to ensure that the functions and the duration of life is not effected. Because of the different manufacturing technologies and the scattering of the product parameters within a homogeneous set of pacemakers we are not able to specify a guaranteed value for the radiation resistance.
Conclusions: The doses of pacemaker should be as minimal as possible. The patient's pacemaker system has to be controlled in adequate periods, in particular during radiotherapy. If the accumulate dose on the pacemaker system exceeds 5 Gy despite of all efforts, the pacemaker should be exchanged after the radiotherapy.