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September 2, 2009

Physician Certification and Implantable Cardioverter-Defibrillators

JAMA. 2009;302(9):941-943. doi:10.1001/jama.2009.1234

To the Editor: For ICD implants, electrophysiologists are currently described as the specialists. Electrophysiologists may generally have superior catheter skills and have a higher success rate placing transvenous left ventricular leads for cardiac resynchronization-capable devices (a minority of implants). It appears that thoracic surgeons are relegated to fixing implant complications (removing infected devices, managing cardiac perforations) and performing the more difficult primary implants: subpectoral implant in cachectic patients, subcutaneous implant in morbidly obese patients, and implants in patients with complex anatomy who have failed initial attempt by an electrophysiologist.

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