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Cardiac Resynchronization Therapy (CRT)

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An illustration of Cardiac Resynchronization Therapy (CRT).
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Cardiac Resynchronization Therapy (CRT): An Overview

Cardiac resynchronisation therapy, or CRT, is a treatment to improve your heart’s pumping function using a pacemaker. CRT pacemakers integrate the timing of the atria or the upper heart chambers and ventricles or your lower heart chambers. Also known as Biventricular pacemaker therapy, the procedure restores the ventricles' normal coordinated pumping action by overcoming the electrical conduction system delay(LBBB). Thereby, it improves the pumping efficiency of your heart and relieves it from failure.

Dr. Karthigesan’s expertise in cardiac device therapy has helped thousands of patients improve their life quality. In addition to researching and practicing the latest cardiac treatments, his reputation for demonstrating compassionate and empathetic cardiac care is unparalleled. Trusting his expertise and experience could be the best gift you give your heart.

Image shows the Cardiac Resynchronization Therapy with the device and catheters.
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The image of a heart with pulse signals illustrates Cardiac Resynchronization Therapy.
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Types of Cardiac Resynchronization Therapy

Cardiac Resynchronization Therapy with a Pacemaker (CRT-P)
The CRT-P is designed with three leads. These wires connect the pacemaker to the right atrium and to both the ventricles to improve the pumping function of the heart( ejection fraction).
Cardiac Resynchronization Therapy with a pacemaker and an ICD (CRT‑D)
The CRT-D is for heart failure patients with a high risk of Sudden Cardiac Death. Apart from improving the pumping function of the heart, it can also detect and treat dangerous arrhythmias by delivering an electric shock stronger than that of a pacemaker to reset your heart rhythm.
The image shows the placement of an artificial pacemaker in the heart.
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Cardiac Resynchronization Therapy (CRT): Evaluative Tests

Dr. Karthigesan will recommend the following diagnostic test before your procedure:

Cardiac Resynchronization Therapy: The Procedure
  • The CRT procedure is performed to implant a device in the chest to enable easier and more organised contraction of the heart’s chambers.
  • To implant the device in your chest, Dr Karthigesan will administer a local anaesthesia at the left shoulder region, below your collarbone.
  • During the procedure electrodes or insulated wires are inserted into a major vein near your collarbone.
  • From here, the electrodes are moved to the heart using X-ray images to guide the device.
  • At the location, one end of each wire is attached to the designated position in your heart and the other end to a pulse generator implanted under your collarbone.
  • The battery life of your CRT device is usually expected to last for 7 to 10 years. It depends on the kind of therapy your receive and how the settings are customised.
The image shows the placement of a CRT device in the heart.
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CRT Heart Procedure: Before, During & After The Procedure
  • Discuss the health risks and benefits of the CRT procedure with your doctor.
  • Inform your doctor about your prescription medicines, general allergies, anaesthesia allergies and recent bouts of colds or infections.
  • Avoid any food or drink after midnight the previous day of your procedure.
  • Avoid taking your routine blood thinners ONLY on advice from Dr. Karthigesan.
  • You will be given medicines to help you sleep and relax. Dr Karthigesan will also numb the area where the CRT device will be placed.
  • You will be given pain medication, fluids, and antibiotics through an IV line in your arm.
  • When the anaesthetic has taken effect, your doctor will make a small pocket-like bruise under your skin to place the CRT battery and wires.
  • X-ray images are used to ensure the leads are placed on the right place on both sides of your heart.
  • Your heart rate, oxygen levels and blood pressure levels throughout the procedure.
  • Your doctor may need to adjust your CRT device's settings over the course of a day or two while you're in the hospital.
  • You must follow your doctor’s instructions and stick to all the follow-up schedules.
  • Avoid stretching, lifting, and other strenuous activities for the first six weeks.
  • Consult your doctor once in six months to check the device's functioning.
  • Keep all electric appliances at least 6 inches from your CRT-P device to avoid any electrical devices.
  • Always monitor your bruise site for signs of infection, swelling, bleeding, discharge, redness, etc. Check with your doctor if you have a fever.
Cardiac Resynchronization Therapy (CRT): The Benefits
  • Improves exercise tolerance, heart failure symptoms, and quality of life.
  • Improves symptoms like shortness of breath and prevents repeated hospitalisation for heart failure and improves survival.
  • Reduces your risk of abnormal ventricle heart rhythms and sudden cardiac arrest.
  • It often takes weeks to months for these improvements to be noticed. Some patients may require other treatment options if CRT therapy does not work.
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CRT Treatment for Heart: The Finer Details

In CRT, your doctor implants a third wire to stimulate the lateral wall of the left ventricle, in addition to the standard wires embedded in the right atrium and right ventricle in a dual chamber pacemaker. The device is inserted just under the collarbone on the front of the chest, usually on the left side.

Then the CRT device will be programmed to simultaneously pace the right and left ventricles. This leads to improved coordination of the heart’s pumping function, which improves cardiac output as well as quality of life.

Dr. Karthigesan may recommend CRT if you have the following:

  • Heart failure
  • Mild to severe symptoms of heart failure, like shortness of breath or low tolerance to exercises, despite being on heart failure medications.
  • Cardiomyopathy (weakened and enlarged heart muscle).
  • Significant left bundle branch block.

The Cardiac Resynchronisation Therapy Device (CRT-D) incorporates a defibrillator function to stop life-threatening Ventricular Tachycardia and Fibrillation. Its main function is to deliver a shock during these potentially dangerous arrhythmias and save lives.

You should avoid doing strenuous physical activities and driving. Apart from this, you can lead a normal life. Also, there are no restrictions for handling electronic gadgets after implantation.

You must visit the device clinic every six months for routine checkups and if a device shock occurs. However, newer devices have remote monitoring or Bluetooth-enabled mobile app facilities to closely monitor their functions without frequent clinic visits.

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