Doctor's Training Affects Defibrillator Implant Results
April 22 -- TUESDAY, April 21 (HealthDay News) -- Chances are you've never heard of electrophysiology, but it's a medical subspecialty you should know about if you are one of the 100,000 or so Americans who will have a heart defibrillator implanted this year.
A defibrillator delivers a shock when needed to keep an aberrant heart beating regularly. And the incidence of in-hospital complications is significantly lower when the implant is done by an electrophysiologist rather than an ordinary cardiologist, a thoracic surgeon or a different sort of specialist, according to a study in the April 22/29 edition of the Journal of the American Medical Association.
"Electrophysiology is a subspecialty within cardiology," explained study author Dr. Jeptha P. Curtis, an assistant professor of medicine at the Yale University School of Medicine's section of cardiovascular medicine. "You have to undergo two years of advanced training on the electrical activity of the heart to be eligible for board certification."
The study of a registry of 111,293 defibrillator implants, done between January 2006 and June 2007, found that 70.9 percent of them were performed by electrophysiologists; 21.9 percent were performed by other cardiologists; 1.7 percent by thoracic surgeons; and 5.5 percent by other specialists.
When the procedure was done by an electrophysiologist, complications occurred in 3.5 percent of cases. The incidence was 4 percent for other cardiologists, and 5.8 percent for thoracic surgeons, according to the study.
"Our study suggests that, in general, people are better served by having them [defibrillators] implanted by electrophysiologists," Curtis said.
Another marked difference found in the study concerned people who require an implanted defibrillator that provides cardiac resynchronization therapy (CRT-D). "These are patients with heart failure, in which the heart is not only weak and inefficient but also beats in a disorganized way," Curtis explained.
While a standard implanted defibrillator has one or two "leads" -- electrical wires attached to deliver impulses to the heart muscle -- a CRT-D device uses three leads to keep the heart beating properly. Nearly one-third of the people in the study met criteria for a CRT-D implant, and the likelihood that they would get one was significantly higher when the procedure was done by an electrophysiologist, the study said.
