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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
- 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.
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.
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.
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.
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.
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.
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