Abstract 4658: Association of Implanting Physician Certification with Complications Following Implantable Cardioverter-Defibrillator Procedures: Insights from the ICD Registry
The training of physicians who implant ICDs varies, but it is not known whether certification is associated with differences in procedural complications. We determined the certification of 2128 physicians who submitted ≥ 10 ICD implants to the ICD Registry between April 2006 and December 2007. We excluded patients with prior ICD, an epicardial lead, or aged ≤18, leaving 111,293 patients for analysis. Physicians were grouped into mutually exclusive categories by highest current certification- Electrophysiology (EP), Cardiovascular disease (CVD), Thoracic Surgery (TS), Internal Medicine (IM), Heart Rhythm Society alternative pathway (HRS), and Other. We compared crude complications rates across physician categories and stratified analyses by device type. A logistic regression model was developed to determine the association of physician certification and risk of in-hospital complications adjusting for demographics, cardiac status, comorbidities, and device type. The majority of implants were performed by physicians with EP certification (Table⇓). Crude complication rate of EP implants was significantly lower than those of other physician groups, and these differences were more pronounced among patients receiving a dual chamber or biventricular device. In multivariable analysis, the risk of any complication was significantly higher among patients who had an ICD implanted by either a CV or TS physician compared with EP physician (EP: Reference; CVD: RR 1.11, 95% CI 1.01–1.21; TS: RR 1.40, 95% CI 1.11–1.76). Differences in risk of complications between EP and other physician categories were not statistically significant. A third of ICDs are implanted by physicians who are not EP certified, and procedural complications vary significantly across physician categories. These findings suggest clinicians should consider implanting physician certification when referring patients for ICD implantation.