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Getting an ICD Heart Device? New Advice

Check Doctor's Experience at Implanting the Devices, Study Suggests
By
WebMD Health News
Reviewed by Louise Chang, MD

Oct. 11, 2005 -- Practice may not make perfect, but it may be a plus for doctors who implant heart devices called ICDs.

ICDs are implantable cardioverter defibrillators. They're tiny devices placed under the skin, with electrodes leading to the heart. If the heart starts beating at a dangerous rhythm, the ICD can shock it back to a normal rhythm.

ICD placement may be recommended by a cardiologist for people with a history of certain abnormal heart rhythms and other heart conditions that have high risk for a dangerous heart rhythm. These may include some cases of cardiomyopathy and heart failure.

Are doctors with more experience in placing the ICDs better for patients? That's what Sana Al-Khatib, MD, MHS, FACC, and colleagues asked.

In Al-Khatib's study, patients were less likely to have mechanical problems with their ICDs or infections if their doctors did a lot of ICD implantations.

The study appears in the Journal of the American College of Cardiology.

Impact on Patients

The study tracked more than 9,800 Medicare patients for three months after getting an ICD between 1999 and 2001. Patients' doctors implanted on average 1 to 87 ICDs per year.

Patient survival was similar among all patients. But the results differed for mechanical problems and infections.

Patients of doctors who did the fewest ICD implantations per year were more likely to have infections or ICD mechanical problems within three months, the study shows.

Doctors' Experience Counted

"This association suggests that ICD implantation should not be performed by physicians without regard to their procedural volume," write the researchers.

In other words, it might be a good idea to check how often your doctor implants ICDs before getting the procedure.

The study noted how many ICD implantations doctors did each year -- not how many ICDs they'd implanted during their entire career.

The study only included Medicare patients. Medicare patients are "older and are more prone to complications," so the results might not apply to non-Medicare patients, write the researchers.

"However, there is little reason to believe that volume would be less important in younger patients," they add.

Al-Khatib works at the Duke Clinical Research Institute in Durham, N.C. She receives research funding from ICD makers Medtronic and Guidant, states the journal.

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