Management of Implantable Cardiovascular Devices in Patients Undergoing Radiotherapy

The increasing coexistence of oncological disease and cardiovascular implantable technology poses complex clinical challenges that require close collaboration among cardiologists, electrophysiologists, radiation oncologists, and medical physicists. A structured, systematic, and multidisciplinary approach is essential for the safe management of cancer patients with a cardiac implantable electronic device (CIED) undergoing radiation therapy. This document reports a consensus statement issued by the Italian Association of Hospital Cardiologists (ANMCO), aiming to provide practical guidance for clinicians involved across the entire care continuum of this high-risk patient population. A comprehensive pre-treatment evaluation is strongly recommended, including detailed assessment of the type of radiotherapy, treatment planning parameters, device characteristics, and patient-specific cardiac conditions, to minimize the risk of CIED malfunction. Particular emphasis is placed on risk stratification before radiation therapy, as well as on the appropriate timing and modality of cardiological assessments during treatment and in the post-therapy follow-up phase. The document offers an overview of oncological electrophysiology and the mechanisms of radiation-induced damage to cardiac devices with the goal of supporting standardized, safe, and effective clinical practice in this evolving field.