Doctor's Training Affects Defibrillator Impla...(ure in which the heart is not only weak ...),Health

While a standard implanted defibrillator has one or two "leads" -- electrical wires attached to deliver impulses to the heart muscle -- a CRT-D device uses three leads to keep the heart beating properly. Nearly one-third of the people in the study met criteria for a CRT-D implant, and the likelihood that they would get one was significantly higher when the procedure was done by an electrophysiologist, the study said.

CRT-D devices were implanted by electrophysiologists in 83.1 percent of such cases, compared to 75.8 percent when the implants were done by other cardiologists, 57.8 percent by thoracic surgeons and 74.8 percent by other cardiology specialists.

So a physician's training in electrophysiology can rightly be a matter of concern for someone getting a defibrillator, Curtis said. "I think it is reasonable for a patient to ask a doctor what his qualifications are," he said. "It would be very reasonable for patients to ask implanting physicians what are their results, what are the numbers."

Such information should be available at most large medical centers, and "having that information available should be part of normal quality assurance," Curtis said.

Dr. Stephen C. Hammill is a member of the study group, a professor of medicine at the Mayo Clinic, a past president of the Heart Rhythm Society, and a qualified electrophysiologist. He said the study shows that "across the board as a group, electrophysiologists have a better outcome than cardiologists or thoracic surgeons."

"But it does not show what individual physicians' outcomes are," Hammill added. His recommendation is that anyone considering a defibrillator implant "needs to speak with their physician and be sure that the physician is comfortable with the level of expertise and training of the individual who will do the implant."