Monday, September 10, 2007

Buyer Beware

Although I've said it before, now comes data to back me up: lots of defibrillators are being implanted by non-trained personnel:
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.
Although the implant itself is not much more difficult than a conventional pacemaker implant, the real issue is this: (1) will the unskilled doctor be capable of handling unusual circumstances and (2) are the doctors implanting these devices skilled at their follow-up and revision?

The implant of the device typically takes one to two hours of the patient's life to perform, but the follow-up of this device is required is for the rest of the patient's life. I suspect many of the implanting physicians without credentials are often from geographically remote centers without an electrophysiologist nearby. But the real issue in implantation is having enough experience to know when a particular implant approach (such as subpectoral) might be in the patient's best interest by avoiding the later complication of erosion and infection of the device. And there is no substitute for having the skills to manage the patient's device proactively to avoid later complications.

So it's buyer beware out there: find out what your doctor knows and what training he has before you commit to any surgery, especially defibrillator implantation.



Anonymous said...

That's a wise statement. Do you support MTWA screening yet?

Anonymous said...

Funny you should mention it. I was lying on the beach during our family vacation this summer and overheard an ICD rep talking to a friend about how she was called in to help a doctor do an implant. Seems the doctor wasn't familiar with the procedure and was improperly planting the lead when the call went out for help. All I know is that this was a New York City hospital. Sent shivers up my spine!