Need a heart defibrillator? Call a specialist

Heart patients who get a defibrillator from doctors who specialize in the heart's electrical system fare better than those whose devices are implanted by other types of doctors, U.S. researchers said on Tuesday.

They also are more likely to get a newer device that is harder to implant but that treats heart failure, they said.

Implantable heart defibrillators, or ICDs, can detect deadly heart rhythms and shock the heart back to normal, saving a patient from cardiac arrest.

ICDs, which represent a $6 billion global market for companies like Medtronic Inc, Boston Scientific Corp and St. Jude Medical Inc, are implanted under the skin with wires leading to the heart.

Electrophysiologists, with extra training in diagnosing and treating abnormal heart rhythms, often implant them. But other doctors can too, and that has led to a debate about who does the best job.

Dr. Jeptha Curtis of Yale University School of Medicine in Connecticut and colleagues used a national registry of more than 100,000 ICD patients to try to answer that question.

"It's a question that has been on the forefront of a number of regulators and payers (minds) for awhile," Curtis, whose study appears in the Journal of the American Medical Association, said in a telephone interview.

He and colleagues grouped patients by the type of specialist who implanted the device. Categories included electrophysiologists, cardiologists who were not electrophysiologists, thoracic surgeons and other specialists.

They found that 70.9 percent out of 111,293 ICD implants were done by electrophysiologists, 21.9 percent were done by other cardiologists, 1.7 percent were done by thoracic surgeons and the rest were done by other specialists.

The heart electricians' patients had the fewest complications. Curtis said the differences were "modest" but "not ignorable."

They also found electrophysiologists were better at picking the best devices for the job, with more recommending ICDs with special features that synchronize the heart's contractions.

"On average, they have lower complication rates and they are more likely to implant the right device for the right patients," Curtis said of electrophysiologists.

By Julie Steenhuysen
CHICAGO (Reuters)