Abstract 2434: Replacement of Cardiac Rhythm Devices: Is the Risk Different When Performed by Trained Electrophysiologists, in Academic or Private Practice? Results From the REPLACE Registry
Introduction: An increasing number of cardiac rhythm management (CRM) devices require replacement annually. It is not known whether the complication rate related to these procedures is higher when the procedures are being performed in academic centers vs. private practices, or if the operator is a trained electrophysiologist (EP) or a non electrophysiologist (NEP).
Methods: The complication rates from pacemaker and ICD replacement procedures have recently been quantified from the prospective multicenter REPLACE Registry. Patients from 68 US centers were enrolled prospectively and were followed for 6 months to determine pre-defined major and minor complications. Cohort I of REPLACE (replacement without a planned lead revision) identified a major complication rate of 4.2% and a minor complication rate of 7.3%. Further prespecified analysis of the Cohort I data was performed to examine the above questions. P values were calculated by the Fisher’s Exact Test.
Results: A total of 1,031 patients were enrolled between July 23, 2007 and March 18, 2008. The complication rates involving EP vs. NEP, academic vs. private practice operators are shown. EP physicians replaced a higher number of ICDs than NEPs (51.3% vs. 32.4%, p<0.001).
Conclusions: When a CRM generator replacement is performed, the complication rate is independent of the academic or private practice of the performing physician. EP physicians have a higher total complication rate than NEPs, a phenomenon that is likely explained by the different patient populations they treat.