Overview

Cardiac Resynchronisation Therapy (CRT) is an advanced treatment for heart failure that uses a specialized pacemaker or defibrillator to coordinate the pumping action of your heart. The device helps the heart's lower chambers (ventricles) beat together in a more synchronized pattern, improving the heart's efficiency. CRT comes in two main types:

 

CRT-P (Pacemaker): Helps coordinate heart rhythm but does not provide defibrillation.

CRT-D (Defibrillator): Provides both heart synchronization and can deliver electrical shocks to treat dangerous heart rhythms.

 

This therapy is typically recommended for patients with moderate to severe heart failure who have a specific type of electrical delay in the heart (called bundle branch block) that causes the ventricles to beat out of sync.

 

Before the Procedure

Pre-Procedure Evaluation: Your doctor will conduct a comprehensive assessment including medical history, physical examination, ECG, echocardiogram, and possibly other tests to determine if CRT is appropriate for you.

 

Medication Review: Your healthcare team will review your current medications and provide instructions about which ones to continue or temporarily stop before the procedure.

 

Preparation: You will likely be instructed not to eat or drink for 8-12 hours before the procedure. The insertion site will be cleaned and prepared.

 

Anesthesia: The procedure is typically performed under conscious sedation (medication to help you relax) or light general anesthesia.

 

During the Procedure

1. Accessing the Vein: The surgeon makes a small incision, usually below your collarbone. A large vein is accessed through this incision.

2. Lead Placement: Unlike a standard pacemaker that typically uses one or two leads, CRT requires an additional lead. Three leads are carefully guided through the veins: One lead is positioned in the right atrium (upper chamber), One lead is positioned in the right ventricle (lower chamber) and the third lead is placed in a vein on the outer surface of the left ventricle.

3. Testing the System: The leads are tested to ensure proper placement and function.

4. Device Connection: The leads are connected to the CRT device (generator), which is then placed in a pocket created under the skin in your upper chest.

5. Programming: The device is programmed to optimize the timing of electrical impulses to your heart chambers to improve synchronization.

6. Closure: The incision is closed with sutures or surgical glue and covered with a sterile dressing.

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After the Procedure

Hospital Stay: You will typically stay in the hospital for 1-2 days for monitoring.

 

Recovery Period: You may experience some discomfort at the implantation site, which can be managed with medication. Most patients can return to normal activities within a few days to weeks.

 

Wound Care: You will receive specific instructions on how to care for your incision site to prevent infection.

 

Device Optimization: You may need to return for follow-up visits to fine-tune the device settings for optimal benefit.

 

Follow-Up Appointments: Regular check-ups are essential to monitor your heart function, adjust device settings if needed, and check battery life.

 

Remote Monitoring: Many modern CRT devices can be monitored remotely, allowing your healthcare team to check your device function and heart rhythm without requiring an in-person visit.

 

Benefits

Improved Heart Function: CRT can improve the efficiency of your heart's pumping action.

 

Reduced Heart Failure Symptoms: Many patients experience a reduction in symptoms such as shortness of breath, fatigue, and swelling in the legs and ankles.

 

Enhanced Exercise Capacity: Patients often report being able to be more physically active after CRT implantation.

 

Decreased Hospitalisations: CRT has been shown to reduce the need for hospital admissions due to heart failure.

 

Improved Survival: Studies have demonstrated improved survival rates in appropriate candidates for CRT.

 

Better Quality of Life: Many patients report an overall improvement in their quality of life.

 

Protection from Sudden Cardiac Death (CRT-D only): The defibrillator component can detect and treat life-threatening arrhythmias.

 

Risks and Considerations

While CRT has proven benefits for many patients, there are some risks and considerations:

 

Procedural Complications: These include bleeding, infection, blood vessel damage, or reactions to anesthesia.

 

Lead Complications: The leads may dislodge, fracture, or develop other problems that require additional procedures to fix. The left ventricular lead can be particularly challenging to position optimally.

 

Device Infection: There is a small risk of infection around the device, which may require antibiotics or device removal in severe cases.

 

Device Malfunction: Though rare, there is a risk that the device might not function correctly.

 

Inappropriate Shocks (CRT-D only): The defibrillator component may occasionally deliver shocks when they are not needed.

 

Non-Response: About 30% of patients do not experience significant improvement with CRT. Your doctor will assess your likelihood of responding before recommending the procedure.

 

Battery Replacement: The device battery typically lasts 4-8 years, after which the generator needs to be replaced through a minor surgical procedure.

 

Living with a CRT Device

Activity Restrictions: Initially, you should avoid heavy lifting and strenuous arm movements on the side of the implant. After healing, most normal activities can be resumed, but contact sports or activities with a high risk of trauma to the chest should be avoided.

 

Driving Restrictions: You may have temporary driving restrictions after device implantation. Your doctor will advise you on specific guidelines.

 

Electronic Devices: Most household electronics are safe to use, but you should maintain a safe distance from strong magnets and certain industrial equipment.

 

Security Systems: Airport and other security systems may detect your device. Carry your device identification card and inform security personnel about your implant.

 

Medical Procedures: Inform all healthcare providers about your CRT device before undergoing any medical procedures, especially MRI scans, as some may require special precautions or are contraindicated.

 

Electromagnetic Interference: Certain environments with strong electromagnetic fields may temporarily affect device function. Your doctor will provide guidance on specific situations to avoid.

 

Follow-Up Care

Regular Device Checks: Your device will need regular check-ups, either in person or through remote monitoring.

 

Battery Monitoring: Your healthcare team will monitor the battery life of your device and advise when replacement is needed.

 

Medication Adjustments: Your medications may need adjustment following CRT implantation as your heart function changes.

 

Lifestyle Modifications: Your healthcare team may recommend continued heart-healthy lifestyle changes, such as diet, exercise, and stress management.

 

Conclusion

Cardiac Resynchronisation Therapy is an effective treatment option for selected patients with heart failure and specific electrical conduction abnormalities. While the decision to receive a CRT device is significant, many patients experience substantial improvements in symptoms, quality of life, and survival. Your healthcare team will work closely with you to determine if this therapy is appropriate for your specific condition and to provide ongoing support after implantation.

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This leaflet is intended for informational purposes only and should not replace professional medical advice. Please consult your healthcare provider for any questions or concerns regarding your health or treatment options.