Cardiac resynchronization therapy (CRT), also known as biventricular pacing, is a specialized treatment for certain types of heart failure. It involves implanting a device called a CRT pacemaker or CRT defibrillator to improve the coordination and efficiency of the heart’s pumping action. CRT helps synchronize the contractions of the heart’s chambers, specifically the ventricles, to improve overall cardiac function.
Treatments
CRT involves the following treatments:
- CRT Pacemaker: This device is implanted in patients with heart failure who do not require an implantable cardioverter-defibrillator (ICD). The pacemaker sends electrical signals to both ventricles to synchronize their contractions and improve pumping efficiency.
- CRT Defibrillator: This device is used in patients with heart failure who are at risk of life-threatening arrhythmias. In addition to CRT pacing, it also provides defibrillation shocks if needed.
Before the procedure
Before the CRT procedure, several steps are taken:
- Evaluation: The patient’s medical history, heart function, and suitability for CRT are assessed through various tests, including electrocardiogram (ECG), echocardiogram, and other imaging studies.
- Medication Adjustment: Medications for heart failure management may be adjusted to optimize the patient’s condition before the procedure.
- Informed Consent: The healthcare team discusses the procedure, potential benefits, risks, and complications with the patient, ensuring an informed decision.
During the procedure
- Anesthesia: The procedure is performed under local anesthesia, with sedation to keep the patient comfortable.
- Device Implantation: One or more leads are inserted through a vein and positioned in specific locations within the heart. These leads are then connected to the CRT pacemaker or defibrillator device, which is usually placed under the skin near the collarbone.
- Programming: The device is programmed to deliver electrical impulses that synchronize the ventricular contractions and optimize the heart’s pumping function.
After the procedure
After CRT implantation, the patient will be monitored in the hospital for a short period before being discharged. Post-procedure care involves:
- Monitoring: Regular follow-up appointments are scheduled to monitor the device function, adjust settings, and evaluate the patient’s response to therapy.
- Medication Management: Medications for heart failure management may be continued or adjusted as needed.
- Lifestyle Modifications: Adopting a heart-healthy lifestyle, including regular exercise, a balanced diet, smoking cessation, and weight management, is important for overall heart health.
Advantages
- Improved Heart Function: CRT helps synchronize the ventricular contractions, leading to improved pumping efficiency and cardiac output.
- Symptom Relief: Many patients experience relief from symptoms of heart failure, such as fatigue, shortness of breath, and exercise intolerance.
- Enhanced Quality of Life: With improved heart function, patients often experience an improved quality of life and the ability to engage in daily activities.
Risks and complications
- Infection: Infection at the site of device implantation is a potential risk.
- Bleeding or Hematoma: Bleeding or collection of blood at the implantation site may occur.
- Lead Displacement or Malfunction: The leads may shift or malfunction, requiring repositioning or replacement.
- Pneumothorax: A collapsed lung may occur as a rare complication of lead placement.
- Allergic Reactions: Some patients may experience allergic reactions to the materials used in the device.
Typical recovery time
The recovery time after CRT implantation is usually short, with most patients able to resume normal activities within a few days. However, it is important to follow the health care team’s guidance regarding activity restrictions and wound care.
Results and post-procedure care
CRT has shown significant benefits in improving heart function, reducing symptoms, and enhancing the quality of life for eligible patients with heart failure. Regular follow-up appointments are essential to monitor device function, adjust settings, and optimize therapy. Patients should promptly report any concerns, such as new or worsening symptoms, to their healthcare provider. Adherence to medication, lifestyle modifications, and ongoing management of heart failure are crucial for long-term success.