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Cardiac Resynchronization Therapy CRT and CRTD implantation

Cardiac Resynchronization Therapy CRT and CRTD implantation

Cardiac Resynchronization Therapy CRT and CRTD implantation, Mukundapur

Cardiac Resynchronisation Therapy (CRT) is a procedure to place a biventricular pacemaker to synchronise both the heart ventricles simultaneously. This procedure is primarily used to treat heart failure patients who have not responded to other treatment modalities. The biventricular pacemaker has three wires or leads. One lead goes to each ventricle, while the third one goes to the heart’s upper chamber. These leads monitor the heart rhythm and send electrical signals to correct abnormal rhythms to ensure all chambers synchronise. The implantation of the device helps reduce abnormal heart rhythm in ventricles, improves shortness of breath, and helps the heart pump more efficiently. Therefore, improving the patient’s quality of life. 

CRTD, also known as Cardiac Resynchronisation Therapy with a defibrillator (CRT-D), is a procedure in which specialised devices are implanted in the body to help manage heart failure. This device delivers electrical impulses to the lower chambers of the heart (ventricles) to maximise synchronisation and efficiency. It also acts as a defibrillator, detecting and correcting life-threatening exercises by delivering shock as needed. Cardiac Resynchronization Therapy CRT And CRTD Implantation is often recommended for patients with severe heart failure who do not respond well to other treatments.

FAQ's

Cardiac Resynchronisation Therapy uses a biventricular pacemaker to help your ventricles function in synchronisation. Whereas, an Implantable Cardioverter Defibrillator (ICD) helps restore a fast heartbeat to normal. Some people will need the implantation of a biventricular pacemaker with an ICD to correct all heart ailments.
 

A Cardiac Resynchronisation Therapy device helps treat heart failure by sending small electrical signals to both lower chambers of the heart to help them beat together with synchronisation. This allows the heart to pump blood and oxygen throughout the body.
 

A CRT device consists of two main components: a pulse generator (device) and leads (thin insulated wires). The device imparts small amounts of electrical signals to the heart with these leads. 
 

There are two types of devices:

Cardiac Resynchronisation Therapy Pacemaker (CRT-P): The device functions like a normal pacemaker and also delivers small electrical impulses to the left and right ventricles to contract simultaneously.

Cardiac Resynchronisation Therapy Defibrillator (CRT-D): It's a special device employed for heart failure patients with a sudden risk of cardiac arrest. It functions similarly to a pacemaker and delivers small electrical impulses to the left and right ventricles, enabling them to contract simultaneously.

Additionally, it also treats dangerously fast heart rhythms that can cause sudden cardiac arrest. When the device senses a fast heartbeat, it sends a shock to the heart. Without this therapy, the rapid heartbeat can cause death within minutes.
 

Individuals with moderate to severe heart failure and who have developed arrhythmia can undergo CRT. The treatment is considered when other treatment modalities fail to provide results. Additionally, implantation of a CRT device benefits patients with cardiomyopathy (weakened or enlarged heart muscle) and significant left bundle branch block.

You may undergo imaging tests, such as a heart MRI, before the procedure. Doctors advise you to stop eating and drinking a few hours before the procedure.
 

On a table beneath an X-ray machine, you will be instructed to lie on your back. The images help guide the doctor to implant the device, but you will need to stay still to avoid distortion of the X-ray images.

Three wires will be inserted through your veins in the upper body or thigh, and the wires will be guided towards your heart. An incision is made below the collarbone to insert the CRT device. The wires are connected to the CRT device and implanted underneath your skin.

During the procedure, the doctor may test the shock function of the CRT-D device by causing a life-threatening heart rhythm in a controlled situation. When the CRT-D successfully administers shock therapy, the incision is closed.
 

After the procedure, you will have to spend a few hours or overnight in the hospital. Doctors advise you to keep your left arm still for about 12 hours after CRT implantation to help keep the leads in place. An X-ray might be taken to check the position of leads, and an EKG might be taken to check your heart rhythm. You will be provided an ID with information about the device before discharge.

You may experience some bruising or discomfort in the area of the CRT device that can last for several weeks. A sterile dressing is often placed over the area for 6 days to promote healing.
 

Most patients can return to their normal routine within a few days. However, patients should avoid lifting heavy objects or driving for a week or more.
 

  • Improves heart efficiency by supporting the heart’s function of pumping blood

  • Improves shortness of breath or other heart failure symptoms

  • Reduces the incidence of abnormal heart rhythm in ventricles

  • Improves your life expectancy and quality of life

  • Improvement in exercise tolerance

  • Reduces the need for hospitalisation

However, according to recent studies, a small number of patients did not see any improvement in their condition even after the procedure. 
 

CRT implantation is a very common and low-risk procedure. However, you must be aware of the possible complications before seeking early care. Possible complications of CRT therapy include:

  • Swelling or bruising in the area where the CRT device is placed

  • Mechanical problems with the CRT device

  • Breaking or dislodging of the leads

  • Infection

  • Blood clots

  • Allergic reaction to the anaesthesia

  • Worsening of kidney function

  • Pneumothorax

  • Heart attack

  • Frequent hiccup sensations are due to the wire on the left side activating the nerve to the diaphragm. This issue can be fixed by programming the device.

If the lead dislodges or malfunctions, you may have to undergo additional procedures to reposition or replace the defective components.

Several factors influence the outlook for the patients who have undergone CRT procedures. However, the procedure is known to improve heart function and reduce symptoms. Therefore, decreasing the need for urgent medical interventions or hospitalisation. Additionally, it improves survivability in patients with severe heart failure symptoms and reduced heart function.
 

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