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Cardiac Resynchronization Therapy (CRT): Definition and Devices

Cardiac Resynchronization Therapy (CRT) treats symptoms and other complications of heart failure (HF). HF is a common problem in which, the pumping task of the heart is affected because the heart does not contract or relax correctly.

CRT is performed using a pacemaker, which is then called a CRT-P, or an Implantable Cardioverter Defibrillator (ICD), with bradycardia pacing capabilities, called a CRT-D. The device is implanted just like a standard pacemaker or ICD, except that a third pacing lead is added to help stimulate the heart’s left lower chamber (left ventricle or LV). Learn More About Heart Failure & Cardiac Resynchronization Therapy (CRT).

  • CRT Devices
  • ICDs (CRT-D)
  • Catheters & Leads
  • Pacemakers
  • Remote Monitoring

CRT stimulates both of the heart’s lower chambers for more efficiency in pumping blood to the body. The stimulation is performed through a pulse generator and pacing leads, placed next to the heart tissues.

The CRT-D or CRT-P is typically implanted under local anesthesia, which minimizes the discomfort while implant the pacemaker. It thus alleviates the discomfort at the implant site, though the patient may feel some pressure. The area being operated upon will be draped so you won’t see anything. You will be awake but relaxed during the surgery. You will hear the doctors and nurses moving around you may communicate during the procedure.

What to expect before Cardiac Resynchronization Therapy (CRT)?

Like most other surgeries, the patient will not be able to eat or drink for a short time before the operation. Most CRT device recipients are sedated, while some may receive general anesthesia. CRT devices are generally implanted just under the skin of the upper chest. This part of the body is shaved, scrubbed, and painted with a disinfectant to clean it.

Complications & Risks

CRT device is implanted through surgery, and like any other surgery, it involves risks. Only a small percentage of CRT patients develop a complication following an implant surgery. They may include infection, reaction to a drug used in surgery, blood loss, damage to blood vessel, heart wall, or an organ. After the surgery, there will be some discomfort with tiredness, which will subside in due time.

Check out the Patient Testimonial, where the patient shares about their success stories from treatments through India Cardiac Surgery Consultants.

What to Expect During Cardiac Resynchronization Therapy (CRT)?

CRT device implantation takes place in a special operating room full of equipment and medical personnel. The patient will lie on a bed with safety straps placed over the legs and arms secured at the sides, as it is important that they remain still during the procedure. There are different methods of device implantation, and the type of surgery one will undergo depends on factors like prior surgeries and type of device. The CRT device implantation procedure is performed in the following steps:

  • Lead Implantation – begins with the placement of the leads.
  • Transvenous Approach – is the most common technique used at present. Transvenous means through the vein. In this method, a small incision is made near the collarbone and two leads are maneuvered through a vein into the heart’s upper and lower right chambers. An LV lead is placed in a vein on the surface of the left ventricle. The tip of each lead (is positioned next to the heart wall. The device is then implanted under the skin in a specially prepared pocket, usually in the right or left upper chest.
  • Thoracotomy – refers to several types of open-chest procedures. It is performed to attach a lead to the outside of the heart.
  • Sternotomy – is similar to a thoracotomy. The incision is made over the breastbone, or sternum, and the leads are advanced into the heart. This type is commonly performed in coronary bypass and heart valve surgery.
  • Subxiphoid Approach – is also similar to a thoracotomy, with an incision made slightly to the left of the sternum.
Testing

Once a Cardiac Synchronization Therapy is performed and the device is implanted, the leads are tested to ensure proper performance. The types of tests depend on whether you receive a CRT- P or CRT-D for therapy. Sensitivity and threshold settings will be tested, and for a CRT-D, therapy delivery will most likely be evaluated. If the therapy is insufficient, the lead is moved to a different position inside the heart. It is not uncommon for a lead to be repositioned during surgery to get most effective therapy.

Device Implantation

Once testing fulfills the criteria, device is connected to the leads. It is then usually placed under the skin, either near the collarbone or above/ at the waistline.

Additional Testing

Once the device is implanted, more tests are performed to ensure that the system effectively stimulates the heart. If the test results are unsatisfactory, the problem may be with the device. The procedure is concluded only after the leads and devices are tested successfully.

What to Expect After CRT?

After the procedure, the patient will be taken to a recovery room/ a hospital room, or the ICU for a couple of days so that the heart can be carefully monitored. The patient may feel drowsy and experience some soreness at the implant site, which can be managed with pain medication.

Resist the urge to twiddle with the device. Twiddler’s Syndrome is a condition in which the new device and lead can get tangled if the patient pokes at the implant site. Depending on one’s particular case, stay at the hospital anywhere from several hours to several days. It is important to remember that everyone recovers at a different pace.

Recovery

On the return home, it is vital to relax and take it easy. It is common to tire easily after surgery. In case the incision becomes red, hot, painful, swollen, or begins draining fluid, notify the physician immediately, as they could signify an infection.

Avoid sudden, jerky movements with your arms, or stretching or reaching over your head. Confine physical activities while incision is healing. Start taking short walks or engage in any form of easy physical activity to get back into shape. It is very crucial to follow the physician’s instructions on returning to normal activities and for giving the heart its time to heal.

Follow-Up

The post surgical visits will go on for some weeks, so that the doctor can keep a check on how the healing process is going and the device is working. The implanted device stores important information about how the heart is interacting with the system, which only a physician or qualified health care professional can retrieve.

Resuming Physical Activity

After device implant, physical activity can probably be increased over time. It is important for you to build slowly to your normal routines. As you feel more comfortable and confident with your device, however, you may find that you are even more active after receiving the device than before. Some patients who receive a CRT-D may find it difficult to adjust to the device once they get home. This is due to the CRT-D’s ability to defibrillate. If you experience anxiety about your device, talk with family members and your physicians regarding your feelings.

FAQ’s
  • How long will the CRT device last?
    • On an average, CRT-Ps last seven years and CRT-Ds last five years. How long a device lasts, however, depends upon how much energy is required to pace the heart.

     

  • Will I be limited in my activities with the CRT device?
    • Typically, you will be able to continue to engage in activities that you participated in before device implantation. You may find that you feel more energized, because the CRT may help to lessen the symptoms associated with heart failure.

     

  • Will I be able to hear or feel my CRT device?
    • First of all, you won’t be able to hear your device. It will not make any noise. Secondly, you may be aware of your pacemaker or ICD initially, but, over time, this sensation will lessen.

     

  • Are there any dietary restrictions?
    • There are no dietary restrictions associated with your device. There may be dietary restrictions, however, associated with your heart condition. Be sure to follow your doctor’s advice with regard to sodium, fats and sugars.

     

  • Will a cellular phone interfere with my device?
    • You can use a cellular phone with most CRT devices. Ask your doctor about using a cellular phone.

     

  • Will my device set off airport security and interfere with aviation navigation equipment?
    • CRT-Ps and CRT-Ds neither prohibit traveling, nor do they interfere with aviation navigation equipment. Passing through the metal detector at airports will not damage the device, but the metal in it may sound the alarm. If this happens, show security personnel your patient identification card.

     

  • Who is a Candidate for CRT?
    • In general, CRT is for heart failure patients with moderate to severe symptoms and whose left and right heart chambers do not beat in unison. However, CRT is not effective for everyone and is not for those with mild heart failure symptoms, diastolic heart failure or who do not have issues with the chambers not beating together. It is also not suitable for patients who have not fully explored correcting the condition through medication therapies. To date, studies show CRT to be equally effective for both men and women.

     

  • What should I expect during cardiac resynchronisation therapy (CRT) surgery?
    • Typically, the procedure to implant a heart device is done under local anaesthesia. It does not require open-heart surgery and many people go home within 24 hours. Your doctor will provide more detailed information, but most individuals can expect to gradually return to their everyday activities shortly after the procedure.

     

  • What happens when I receive a shock?
    • Experiencing a shock from a CRT device that contains an implantable defibrillator can be a concern for many individuals. An implantable defibrillator shock will most likely take you by surprise.You may feel fine afterward, or you may feel dizzy, sick, or disoriented after the shock occurs. It’s important to talk to your doctor and have a plan in place so that you know exactly what to do when you experience a shock. Your doctor may want you to phone in, or schedule an appointment after you’ve had a shock.

     

  • Will the device affect my appearance?
    • Sometimes individuals wonder if there will be a noticeable bulge where the heart device was implanted. In general, you may notice a slight bump under your skin where your device is located.

     

  • Will I have to change my lifestyle?
    • An implantable heart device allows many individuals to participate in the activities they enjoy. Your doctor will have more information on activities you may need to avoid.If your CRT device contains an implantable defibrillator, this might include activities where a few seconds of unconsciousness could be dangerous to yourself or others. However, most people resume their normal daily activities after full recovery from surgery.

     

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