Trainee inexperience is associated with longer procedure times but no increase in complications for cardiac device implantation

Rahbar, Ata Soleimani; Hsu, Jonathan C.; Han, Frederick T.; Nguyen, Nhan; Kwon, Minkyung; Azadani, Peyman N.; Marcus, Gregory M.; Lee, Byron K.

doi:10.1016/j.hrthm.2013.09.003

Cited by 9 publications

(8 citation statements)

References 5 publications

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“…As expected, trainees have been shown to have, in general, longer FT as compared with their supervisors [3,4]. However, it is unknown if cardiology trainees improve their efficiency in performing coronary angiography particularly in the first few years of training.…”

Section: Introductionmentioning

confidence: 55%

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Learning Curve for Transradial and Transfemoral Coronary Angiography amongst Cardiology Trainees

Khialani¹,

M²,

Aw³

2018

Interv Cardiol J

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A decrement in fluoroscopy time (FT) is one objective measure of competency in coronary angiography. Aims:To establish if a difference in FT exists between consultants and trainees, investigate if trainees have shorter FT with increasing seniority, compare transradial (TR) and transfemoral (TF) FTs of trainees, and determine a minimum number of TR cases to overcome the potential "learning curve". Methods and results:The total, TF and TR FTs in patients was assessed over four years. Cases were dichotomized to with trainee (trainee) or without trainee (consultant) present in the catherization laboratory. Complex cases were excluded. 1699 patients underwent diagnostic coronary angiography during the study period, where the trainee was present in 707 cases. Patients in the trainee cohort were older, but there was no other significant difference in demographics. The presence of a trainee resulted in longer FTs (6.0 versus 3.9 min, p<0.001). The median FT of trainees improved between their first and second fifty cases (6.5 mins vs 5.2 mins, p-value<0.0001). After the first 50 TR cases, median trainee TR FT fell within the IQR of consultants. Conclusion:Cardiology trainees have longer total, TF and TR fluoroscopy times compared to consultant cardiologists. However, these times improved with increasing experience.

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Section: Introductionmentioning

confidence: 55%

“…Trainee inexperience has been found to be associated with longer procedure times as assessed by fluoroscopy time [3,4]. Jensen et al determined a caseload of 150 coronary angiographies to obtain competency-defined as a median fluoroscopy time within the IQR of an expert [2].…”

Section: Discussionmentioning

confidence: 99%

Learning Curve for Transradial and Transfemoral Coronary Angiography amongst Cardiology Trainees

Khialani¹,

M²,

Aw³

2018

Interv Cardiol J

View full text Add to dashboard Cite

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“…Because of this unfamiliar dilemma due to inexperience, we were reminded of the so-called "July phenomenon" (when there is a perceived decrease in the quality of health care at the start of the North American academic year for medical training) [14] . Although the July phenomenon has been largely refuted,an abundance of evidence that "surgeon volume" matters across a range of operations including electrophysiology procedures [15,16] .…”

Section: Discussionmentioning

confidence: 99%

Incomplete endothelialization of WatchmanTM Device: Predictors and Implications from Two Cases

Frisch

Dikdan

2019

Journal of Atrial Fibrillation

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Background: A major innovation in atrial fibrillation (AF) ablation has been the introduction of contact force (CF) sensing catheters. Objective:To evaluate procedural and clinical effects of transitioning to CF-guided AF ablation. Methods:Consecutive AF ablation patients were studiedduring the period of time of transitioning from a non-CF to CF sensing catheter. Procedural data recorded was total radiofrequency time, time to isolate the left pulmonary veins (LPVs), and time to isolate the right pulmonary veins (RPVs). Clinically, the 3 and 12-month maintenance of sinus rhythm was noted and compared by: paroxysmal vs. persistent AF; CT scan LA volume more or less than 150 cc; CHA 2 DS 2 VASC more or less than 2; and LVEF more or less than 55%. Safety data was recorded as well. Results: Total ablation times were shorter (113 vs.146 min, p=0.011)when using the CF catheters compared to non-CF ablations. This was driven by a decrease in both LPV (46 vs.72 min, p<0.001) and RPV time (54 vs. 75 min, p=0.002).The use of CF catheter did not change the overall percentage of patients in sinus rhythm at 3 and 12-months of follow up. However, sinus rhythm was more frequent at 12 months with CF ablation in patients with a LA volume of more than 150 cc when compared to non-CF ablation (84.6% and 52.4%, p=0.03). There was no difference in outcomes with stratification by CHA 2 DS 2 VASC score or LVEF. No significant difference in complications was noted. Conclusions:For AF ablation, the initial use of CF-sensing technology reduced procedure times with similar overall sinus rhythm maintenance at 3 and 12 months. CF improved 12-month outcomes in patients with an enlarged LA.

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“…Fluoroscopy time (FT) has been suggested as an objective measure of proficiency where a decrement in FT time indicates increasing competency [2]. As expected, trainees have been shown to have, in general, longer FT as compared with their supervisors [3,4]. However, it is unknown if cardiology trainees improve their efficiency in performing coronary angiography particularly in the first few years of training.…”

Section: Introductionmentioning

confidence: 99%

Learning Curve for Transradial and Transfemoral Coronary Angiography Amongst Cardiology Trainees

Khialani

Hutchison

Mok

2018

Heart, Lung and Circulation

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A decrement in fluoroscopy time (FT) is one objective measure of competency in coronary angiography. Aims:To establish if a difference in FT exists between consultants and trainees, investigate if trainees have shorter FT with increasing seniority, compare transradial (TR) and transfemoral (TF) FTs of trainees, and determine a minimum number of TR cases to overcome the potential "learning curve". Methods and results:The total, TF and TR FTs in patients was assessed over four years. Cases were dichotomized to with trainee (trainee) or without trainee (consultant) present in the catherization laboratory. Complex cases were excluded. 1699 patients underwent diagnostic coronary angiography during the study period, where the trainee was present in 707 cases. Patients in the trainee cohort were older, but there was no other significant difference in demographics. The presence of a trainee resulted in longer FTs (6.0 versus 3.9 min, p<0.001). The median FT of trainees improved between their first and second fifty cases (6.5 mins vs 5.2 mins, p-value<0.0001). After the first 50 TR cases, median trainee TR FT fell within the IQR of consultants.Conclusion: Cardiology trainees have longer total, TF and TR fluoroscopy times compared to consultant cardiologists. However, these times improved with increasing experience. Figure 4Overall, radial and femoral trainee learning curves when compared to consultant cardiologists.

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Trainee inexperience is associated with longer procedure times but no increase in complications for cardiac device implantation

Cited by 9 publications

References 5 publications

Learning Curve for Transradial and Transfemoral Coronary Angiography amongst Cardiology Trainees

Learning Curve for Transradial and Transfemoral Coronary Angiography amongst Cardiology Trainees

Incomplete endothelialization of WatchmanTM Device: Predictors and Implications from Two Cases

Learning Curve for Transradial and Transfemoral Coronary Angiography Amongst Cardiology Trainees

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