Cardiac Implantable Electronic Devices in Oncology Patients: Challenges and Management

The use of cardiac implantable electronic devices (CIEDs) in patients with cancer is rising, given the increasing prevalence and incidence of cardiovascular disease in this population, such as arrhythmias and heart failure. Device therapy in oncology patients presents unique clinical, procedural, and ethical challenges, not completely addressed by current guidelines. This review summarizes current evidence regarding the indications, implantation challenges, long-term management, prognostic considerations and emerging technologies related to CIED therapy in oncology patients. Cancer-specific factors, such as thrombocytopenia, immunosuppression, prior surgery, and radiation-induced anatomical changes, complicate device implantation and follow-up. Increased infection risk, venous thromboembolism, and altered pacing thresholds, particularly in conditions like cardiac amyloidosis, require individualized approaches. The integration of leadless pacemakers, subcutaneous implantable cardioverter defibrillators (ICDs), wearable defibrillators, and remote monitoring offers promising alternatives for high-risk patients. Prognostic considerations and ethical dilemmas, including ICD implantation in patients with limited life expectancy and device deactivation at end-of-life, necessitate multidisciplinary decision-making. Future research and collaborative efforts are essential to address cancer-specific complexities and bridge existing gaps to optimize care for this growing patient population.