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Defibrillator Implant Success Varies by Specialty

Last Updated: April 21, 2009.

 

Electrophysiologists have fewer complications and are more likely to implant most appropriate device

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Patients who receive an implantable cardioverter-defibrillator are more apt to get the most appropriate device and are less likely to suffer complications if an electrophysiologist performs the procedure, according to a study reported in the April 22 issue of the Journal of the American Medical Association.

TUESDAY, April 21 (HealthDay News) -- Patients who receive an implantable cardioverter-defibrillator (ICD) are more apt to get the most appropriate device and are less likely to suffer complications if an electrophysiologist performs the procedure, according to a study reported in the April 22/29 issue of the Journal of the American Medical Association.

Jeptha P. Curtis, M.D., of Yale University School of Medicine in New Haven, Conn., and colleagues examined data on 111,293 ICD procedures in 2006 and 2007 to assess the association between the implanting physician's certification and outcomes. In-hospital complication rates and the receipt of a defibrillator with cardiac resynchronization therapy (CRT-D), when indicated, were the measured outcomes. Regression models were used to determine the association of physician certification with outcomes.

Of the total implantations, 78,857 were performed by electrophysiologists, 24,399 by nonelectrophysiologist cardiologists, 1,862 by thoracic surgeons, and 6,175 by other specialists. Researchers found that patients with an ICD implanted by either nonelectrophysiologist cardiologists or thoracic surgeons were at increased risk of complications compared to electrophysiologist implantation: nonelectrophysiologist cardiologists' relative risk (RR) = 1.11 and thoracic surgeons' RR = 1.44. Patients who met the criteria for a CRT-D were less likely to receive that device if implantation was performed by a nonelectrophysiologist: nonelectrophysiologist cardiologists' RR = 0.93, thoracic surgeons' RR = 0.81, and other specialists' RR = 0.97.

"Overall, implantations by a nonelectrophysiologist were associated with a higher risk of procedural complications and lower likelihood of receiving a CRT-D device when indicated compared with patients whose ICD was implanted by an electrophysiologist," the authors conclude.

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