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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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.

It is therefore not surprising that in the study by Dr Curtis and colleagues,¹ the small numbers of primary implants done by thoracic surgeons in recent years had a higher complication rate. As noted here, these are the more difficult patients. Subpectoral implants are particularly prone to pocket bleeding.

The study is also notable for reporting only in-hospital complications. Most infections . . . [Full Text of this Article]

Scott D. Lick, MD
slick@utmb.edu

Andras C. Kollar, MD; Vincent R. Conti, MD
Department of Surgery
University of Texas Medical Branch
Galveston

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