Cardiac Resynchronization

Irregular heartbeats or arrhythmias are caused by various reasons, including advanced age, certain medications, heart damage, and genetics.

Irregular heartbeats or arrhythmias are caused by various reasons, including advanced age, certain medications, heart damage, and genetics.

In heart failure patients, the heart muscle is weakened, making it difficult for the heart to pump enough blood to the entire body. The condition gets worse if the heart chambers aren’t in sync with each other.

Cardiac resynchronization therapy (CRT) is a procedure performed to improve abnormal heart rhythms in patients with heart failure. This procedure helps the heart chambers to pump out blood more efficiently and co-ordinately.

CRT involves implanting a biventricular pacemaker, a device that stimulates the contraction of both the ventricles (lower chambers of the heart). It also synchronises the simultaneous contraction of both the ventricles, to maximise the flow of blood from the heart.

The biventricular pacemaker or the CRT device is a tiny device that contains three wires or leads and a pulse generator. The three wires are connected to the right atrium (upper chamber of the heart) and both the ventricles. The other end of the wires (leads) is connected to the pulse generator, which is placed under the skin in either the upper chest or the abdomen.

When is CRT recommended?

The following conditions are indications for CRT:

  • Severe congestive heart failure
  • Cardiomyopathy (diseases of the heart muscles)
  • Significant rhythm abnormalities affecting the lower chambers of the heart (bundle branch block)

For patients with heart failure, especially who are not responding to medications, CRT is prescribed to improve:

  • Heart function
  • Quality of life
  • Ability to exercise
  • Survival

What are the risks of the procedure?

CRT is not a dangerous type of procedure. However, some risks associated with CRT include:

  • The device or the wires move (may need a second surgery)
  • Mechanical problems of the CRT device
  • Heart rhythm problems
  • Swelling or bruising at the site where CRT device is placed
  • Reaction to the anaesthesia
  • Bleeding
  • Infection

What happens before the procedure?

Several diagnostic tests may be performed to determine whether you require a CRT:

  • Imaging tests such as X-ray, MRI and CT scan
  • Electrocardiogram
  • Echocardiogram
  • Stress Test

Preparations for the procedure:

Here are some guidelines to prepare you for the procedure:

  • Discuss the risks and benefits of the procedure with your healthcare team.
  • Do not eat anything for 8 hours before the procedure.
  • You may be asked to stop taking any blood thinners a few days before the procedure.
  • If you are diabetic, ask your doctor to adjust the dose around the surgery.

Inform your doctor about:

  • Any medicines that you take, including over-the-counter medicines, aspirin, or any other supplements.
  • Allergies (if any)
  • Recent symptoms of infections or cold
  • Problems associated with anaesthesia that you or your family have or had

How is Cardiac Resynchronization performed?

The steps involved in a cardiac synchronization procedure are:

  • Local anaesthesia is administered below the collarbone.
  • An incision is made, and the wires are implanted into the heart via the veins.
  • One end of the wire or lead is connected to the heart, and the other end is connected to the pulse generator.
  • The position of the wire is confirmed by doing an X-ray.
  • The device is tested, and if it is working properly, the incision is closed.

Cardiac resynchronization therapy usually takes around 3 to 5 hours.

What happens after the procedure?

After the surgery, the patient should stay in the hospital for a day or two, as the doctor will check and adjust the settings of the CRT device. The patient needs to restrict arm movements to prevent breaking of the incision.

Before leaving the hospital, your doctor might give you some instructions to be followed at home; which may include:

  • Limit activities like lifting, stretching, straining, for the first 6 weeks. Ask your doctor when you can return to these activities.
  • Clean your dressing regularly and keep it dry. Your healthcare provider will tell you when to remove the dressing.
  • Watch out for the signs of infection near the incision area, such as fever, soreness, redness, swelling, abnormal discharge or bleeding.
  • Follow your normal diet.

Long-term plan for effective treatment:

The following lifestyle modifications should be adopted for effective management of arrhythmias in patients with heart failure:

  • Avoid smoking.
  • Follow a healthy diet.
  • Exercise regularly.
  • Avoid drinking alcohol.
  • Manage stress efficiently.
  • Maintain a healthy weight.
  • Control blood pressure and blood sugar levels.

Living with the CRT device:

Here are some long-term instructions to live with the CRT device:

  • Get your device checked regularly by your doctor, at least once every 6 months.
  • Always carry a CRT pacemaker identification card. Inform your caregivers about your device.
  • The pacemaker battery lasts for about 4 to 8 years. Your doctor will be able to predict about 6 months before the battery runs down. Before the battery runs down, the CRT pacemaker is replaced by a minor procedure.
  • Stay about 6 inches away from all electrical devices, as they can interfere with its function.
  • Stay away from devices that have strong magnetic fields, including electrical generators, microwaves. Ask your doctor which appliances you should avoid.
  • Most metal detectors and X-rays are safe. But avoid metal wands used at the airport screenings and MRI imaging tests.

Call the emergency if you have these complications:

  • Fatigue
  • Weakness
  • Irregular heartbeat
  • Pain in chest
  • Breathlessness
  • Increased urination
  • Swelling in legs
  • Rapid weight gain





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Copyright © 2019, Dr. Raghu. All rights reserved.
Designed & Developed by Deepak Kambhampati.

Copyright © 2019, Dr. Raghu. All rights reserved.
Designed & Developed by Deepak Kambhampati.