Teaching Hospitals and CRT-D Implant

  • by BarbD
  • 2018-10-02 10:05:10
  • ICDs

I am currently going to a teaching hospital in Boston where my EP practices.  We are discussing implanting a CRT-D, and when I asked him if he’d be doing the surgery/procedure he just said “me and my assistant/fellow”. I asked whether he’d be at least doing the lead placement and he repeated me and my assistant would be doing it.  He saw that I was a bit uncomfortable with this and just said he’d be there the whole time overseeing everything.

He said the EP fellows were very good, but everything I read on here stresses the importance of getting a good EP doc to do the implant and it sounds like the fellow will probably do the procedure with the EP doc overseeing it. This makes me very nervous thinking that someone not that experienced will be placing leads in my heart and possible complications.  What do others think about this?   I could try a different hospital/EP but most of the big hospitals in Boston are teaching hospitals so I suspect I will run into the same situation.


At least he was HONEST!

by donr - 2018-10-02 10:29:35

Go to any teaching hospital & that may well happen.

Where & how else will new surgeins learn? In Boston you usually heve the best of trhe best fellows working.  Surgeons will kill to get a fellowship in Boston.  That is NOT beinmg elitist, that is reality.  

The "Attending" surgeon keeps very close watch over what his/her Fellow does.  They do not let them get in over their heads.    They are continually coaching/explaining what to do and how to do it.  Their safety records & success records are quite good - considering that they get some very tacky problems/cases to perform.   

BTW:  There are hundreds of hospitals with Postgraduate traning programs for durgeons.  Last I recall, there were about 104 Med schols in the US producing some 10,000 new physicians annually.  They have to go somewhere to lern their trade as aspecialist of some kind.  The number and tyes of training grounds are vast to absorb all thse new doctors.  IIRC, there are some 500 plus hospitals running Intern/residency programs.  Some are obviously better than others.  Those tranig programs have between 5 & 20 trainees in 4-5 different year programs.   Then you get to the REAL specialties - like becoming an EP.  Those are called "Felowships."  They have been soing surgery for at least 4 yrs by the time thay get into a fellowship, so they are no slouch when it comes to performance.   Usually a fellow works exclusively w/ one surgeon, so there is a lot of close supervision.   

Being in Boston, you will be in very good hands.  Not to worry.


no worries

by Tracey_E - 2018-10-02 10:53:09

That's how the younger doctors get good at it. As long as the doctor overseeing is well qualified and the hospital has a good reputation, I wouldn't hesitate to trust the team. 



by ROBO Pop - 2018-10-02 12:55:39

"Teaching" hospitals typically attract the cream of the cream in medicine. I had open heart surgery for quadruple by-pass and mitral valve replacment at one. Two other hospitals and some renowned surgeons declined my case because they felt my odds of survival were too low.

That was 11 years 8 months ago. I have no doubt, and several unaffiliated specialists concur, I would not be here were it not for the skill and expertise I received at that hospital.

The best part was when they did rounds after surgery and getting to talk to those trainees who actually performed the procedures. I would highly recommend it to anyone.

And by the way a CRT-D implant is a cake walk in comparison.


by BarbD - 2018-10-02 13:56:17

Thanks for the replies - they really help to ease my mind.

CRT-D Implant

by AgentX86 - 2018-10-02 14:55:39

There is nothing special about a  CRT implant that would require _The_Best_ EP. The third (RV) lead is tricky but an experienced EP should be able to handle it. It's not like an ablation where there is only one chance to get it right either (you can't un-burn tissue).


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