Practice makes perfect when implanting cardioverter-defibrillator devices

(BETHESDA, MD) As the implantation of cardioverter-defibrillator devices to prevent sudden cardiac death becomes increasingly popular, patients are likely to get the best results when they are treated by physicians who perform the procedures frequently, according to a new study in the Oct. 18, 2005, issue of the Journal of the American College of Cardiology.

"Defibrillator implantations performed by physicians with low volume are more likely to have adverse outcomes, including infections and mechanical complications. This suggests that defibrillator implantations should be directed toward physicians with a high volume of defibrillator implantations," said Sana M. Al-Khatib, M.D., M.H.S., F.A.C.C. from the Duke Clinical Research Institute in Durham, North Carolina.

This is the largest study of the relationship between the volume of implantable cardioverter-defibrillator (ICD) procedures done by physicians and the outcomes for their patients. The small devices are placed under the skin, with electrodes leading to the patient's heart. If the device detects a potentially life-threatening heart arrhythmia, it can automatically deliver a shock to jolt the heart back into a normal rhythm.

The researchers analyzed Medicare records for 1999 through 2001 to identify patients who received cardioverter-defibrillators and also how many of those patients received hospital treatment for complications within 90 days of the implant procedure. There was no significant difference in death rates between high-volume and low-volume physicians; but mechanical complications were more common among patients of the lowest-volume physicians. Among higher-volume physicians, those who implanted at least 11 devices per year into Medicare patients had similar rates of mechanical complications. Patients of the lowest-volume physicians also suffered significantly more infections around the site of their implants. Because this analysis included only procedures paid for by Med

Contact: Amy Murphy
American College of Cardiology

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