Study on ICD implants turned up a surprise

  • Article by: Janet Moore
  • Star Tribune
  • September 7, 2007 - 9:24 PM

A registry tracking patients with heart defibrillators found that many of the doctors implanting the device had no formal training in the procedure.

The implantable cardioverter defibrillator (or ICD), as the stopwatch-sized device is formally known, is tucked beneath the collarbone in surgery and connected to the heart with insulated wires. It delivers a shock to the heart if an abnormal rhythm is detected.

Data from the National ICD Registry, published in the medical journal HeartRhythm this month, showed that 15 percent of the 3,249 doctors tracked in the registry who implanted defibrillators last year lacked formal training in the procedure. These physicians accounted for 6 percent of all implants included in the registry in 2006.

"I suppose you can look at it and say, 'Gee, it's pretty terrific that 85 percent of physicians have gone through some kind of formal training,'" said Dr. Stephen Hammill, director of the National ICD Registry's steering committee, and a professor of medicine at the Mayo Clinic in Rochester. "But the 15 percent still bothered me."

Formal training involves a fellowship in electrophysiology or cardiac surgery or, lacking that, following training guidelines put forth by the Heart Rhythm Society, a group of electrophysiologists who implant pacemakers and ICDs.

Hammill, a former president of the society, said he hopes the registry data will encourage hospital committees that grant doctors credentials to implant defibrillators to require the society's recommendations for physician training.

The registry tracked more than 108,000 defibrillator implants at 1,117 hospitals nationwide in 2006 using Medicare data.

The data also indicated that complications related to defibrillator surgery occurred in 3.6 percent of the 108,000 implants, actually lower than Hammill expected.

Complications include deaths or dislodging of the leads (or the wires connecting the device to the heart).

The real-world tracking system was demanded by Medicare when it agreed in 2004 to expand coverage of potential ICD patients based on information from a landmark 2,521-patient study called the Sudden Cardiac Arrest in Heart Failure Trial.

Medicare, the nation's health care plan for the elderly, wanted assurances that the therapy was effective in certain patients before agreeing to pay for it.

Hammill said the message to patients considering defibrillator therapy is clear: "Patients need to take it upon themselves to know the physician who is doing their procedure, and asking what their training has been and what their level of experience is."

The registry will continue to track ICD patients for four to five years, providing valuable information on how the technology works in real-world settings, Hammill said.

Janet Moore • 612-673-7752

Janet Moore •

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