Cardiac Resynchronization Therapy (CRT) is a treatment method specially designed for heart failure patients who have synchronization disorders between the two lower chambers (ventricles) of their heart. Unlike standard pacemakers, CRT aims to improve the contraction synchronization of your heart rather than the contraction rhythm. In some patients with heart failure, a synchronization disorder occurs between the left and right ventricles of the heart, causing the heart to work inefficiently. The CRT device increases the heart’s pumping power by restoring this synchronization and improves the patient’s quality of life.
In this article, we will comprehensively discuss what Cardiac Resynchronization Therapy is, when it is needed, pre- and post-procedural processes, its benefits, and potential risks.
What is Cardiac Resynchronization Therapy?
Cardiac Resynchronization Therapy or CRT is a device therapy that regulates your heart’s electrical activity to enable the left and right lower chambers (ventricles) to contract in a more coordinated manner. This device contains a small battery and three thin wires (electrodes) going to the heart. These electrodes are placed in your heart’s right and left ventricles and right upper chamber. The device sends low-level electrical stimuli to your heart, ensuring both ventricles contract synchronously.
Why is Cardiac Resynchronization Therapy Needed?
CRT is needed by patients with moderate or advanced heart failure who do not respond to medication therapy. CRT treatment is especially recommended when your heart’s left ventricle has low pumping power (low ejection fraction) and your ECG shows a “left bundle branch block” indicating synchronization disorder between heart chambers. In patients with this condition, the CRT device increases the heart’s pumping power, reducing symptoms such as shortness of breath and fatigue, and decreases hospitalizations.
The main purpose of CRT is to improve the inefficient contraction of the heart in heart failure. Your doctor performs a comprehensive evaluation to determine whether you are a suitable candidate for CRT. This evaluation includes your ECG, heart ultrasound (echocardiography) results, and the severity of your symptoms. If you have difficulty with daily life activities despite medication therapy and your symptoms persist, CRT may be a suitable treatment option for you.
What is the Pre-Procedure Preparation Process?
The pre-procedure preparation process is very important for safe and successful implantation. Usually, before your hospital admission, you will do the following:
- Medication Adjustments: Your doctor will inform you about blood thinners (aspirin, clopidogrel, etc.) and other medications you use and may ask you to temporarily stop using these medications if necessary.
- Tests: Tests such as blood tests, ECG, and echocardiography are performed to evaluate your heart and general health condition.
- Fasting: Since your stomach needs to be empty on the procedure day, you will be asked not to eat or drink water after a certain time the night before the procedure.
How is a CRT Implanted?
A CRT is usually implanted with a surgical procedure performed under local anesthesia, placed under the collarbone in the chest area. During the procedure, your doctor sends three thin wires (electrodes) to your heart’s chambers through a vascular access. After these electrodes are placed in the correct position, they are connected to the device, and a small pocket is created under the skin where the battery is placed. The procedure takes approximately 1-2 hours, and the patient is usually discharged the same day or the next day.
The stages of CRT implantation are:
- Preparation: The upper part of your chest is numbed with local anesthesia in the procedure room.
- Creating an Incision: A small incision is made just below your collarbone.
- Electrode Placement: Through the incision, a vascular access is made, and three electrodes are advanced toward your heart with the help of a guide wire.
- Electrode Positioning: Electrodes are placed in your heart’s right upper chamber, right lower chamber, and the coronary sinus leading to the left lower chamber. Correct positioning is done under X-ray imaging guidance.
- Device Connection and Placement: The tips of the electrodes are connected to the CRT device, and the device is placed in a small pocket created under the skin.
- Closing the Incision: The incision is closed with stitches.
What Do You Feel After the Procedure?
After the procedure, you may feel mild pain, tenderness, or bruising in the incision area. You can control these symptoms with pain relievers recommended by your doctor. Most patients can stand up and walk shortly after the procedure. After discharge, you should take care to keep the incision area clean and dry. You need to limit your physical activities and avoid heavy lifting or straining your arm for the first few weeks.
What are the Benefits of CRT?
CRT is a treatment that significantly improves quality of life in patients with heart failure. By increasing your heart’s pumping power, it reduces symptoms such as shortness of breath and fatigue. Additionally, it reduces your hospitalizations and helps reduce the risk of death due to heart failure. CRT enables your heart to work efficiently, allowing you to feel more energetic and perform your daily activities more easily.
What are the Risks of CRT Procedure?
As with any surgical procedure, CRT implantation also has some risks. The most common risks are conditions such as infection or bleeding in the incision area. Although rarer, serious complications such as damage to vessels or heart wall during electrode placement, fluid accumulation in the heart, or heart rhythm disorders can also be seen. Your doctor takes all necessary precautions to minimize these risks. Serious complications are rarely seen in experienced centers.
When Should You See a Doctor?
After CRT implantation, while at home, if you notice symptoms such as redness, swelling, or increased pain in the incision area, fever, dizziness, fainting, or worsening shortness of breath, you should consult your doctor or the nearest emergency room without delay. These symptoms may be a sign of an infection or a device-related problem and may require rapid intervention.
Reference: Cardiac Resynchronization Therapy
