It matters who implants your defibrillator

Patients whose cardiac defibrillators were implanted by doctors who didn't specialize in abnormal heart rhythms were likelier to have complications, a study found.

Those whose devices were placed in their chests by thoracic surgeons had a 40 percent increased risk of complications compared with those inserted by the heart-rhythm specialists, called electrophysiologists, according to a report in the Journal of the American Medical Association. Side effects such as pain, infection and bleeding, also increased about 10 percent among patients of cardiologists who didn't specialize in electrophysiology.

Defibrillators are used to treat heart failure, which kills about 300,000 each year and afflicts 5 million people in the U.S., according to the National Institutes of Health. The research turned up evidence that scarcity of electrophysiology specialists isn't a reason why other doctors implant defibrillators, said Douglas Zipes, a former president of the American College of Cardiology and a professor at the Indiana University School of Medicine.

"Patients should vote with their feet," said Zipes, who wasn't involved in the study, in a telephone interview. "There is scientifically credible data to show that the most skilled and trained individual is really one who should be doing this."

The study used data from 111,293 patients in a national registry from January 2006 through June 2007. The analysis was funded by the National Institutes of Health.

The implantable cardioverter defibrillator works by attaching leads, which monitor the heart's rhythm and deliver shocks, to the heart. The leads are attached to a generator, where a battery and computer reside. These devices are typically used for people who are at risk for sudden cardiac arrest, according to the Cleveland Clinic Web site.

Implantable cardioverter defibrillators are made by Medtronic Inc., Boston Scientific Corp., and St. Jude Medical Inc.

About 70 percent of patients have their defibrillators implanted by electrophysiologists, the study found.

Some physicians think that cardiologists who aren't electrophysiologists should be allowed to implant defibrillators, in order to shorten patients' wait times for the devices, according to background information in the article. The study found that two-thirds of patients who underwent the procedure with a nonspecialist did so in a hospital with an electrophysiologist on staff, which suggests the availability of the specialists was not an issue, Zipes said.

"Patients should ask about the qualifications of the person who's implanting these devices," said one of the study's authors, Jeptha Curtis, an assistant professor at Yale University School of Medicine. "They should also feel comfortable asking about complication rates."