What you need to know about:

Cardiac Resynchronization Therapy (CRT)

Fast Fact

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Recovery Period:

1-2 nights in hospital

Permanence:

5-10 years or longer

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Time it takes:

1-3 hours

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Anesthetize:

General anesthesia

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Overview of

Cardiac Resynchronization Therapy (CRT)

in Thailand

Cardiac resynchronization therapy (CRT) involves the implantation of a pacemaker, an electronic device used to treat congestive heart failure by stimulating the left and right lower chambers of the heart to beat appropriately and efficiently. The procedure to place the pacemaker involves a small incision made in the chest, above the collarbone. There are two types of pacemakers that can improve heart function and blood circulation: 1. A regular cardiac resynchronization therapy pacemaker or CRT-P. The device used for cardiac resynchronization therapy has three leads that connect the pacemaker to the right upper chamber of your heart (right atria) and both lower chambers (ventricles). 2. A cardiac resynchronization therapy defibrillator, or CRT-D, can detect when an arrhythmia is life-threatening and automatically shock the heart back into a normal rhythm. Doctors normally recommend the cardiac resynchronization therapy defibrillator (CRT-D), but the final decision on the appropriate device will depend on the individual patient.

Goals of

Cardiac Resynchronization Therapy (CRT)

If you have heart failure, your heart muscle is weakened and may not be able to pump out enough blood to support your body. This can be worsened if your heart's chambers aren't in sync with each other. Cardiac resynchronization therapy may reduce your symptoms of heart failure and lower your risk of heart failure complications, including death.

Price of

Cardiac Resynchronization Therapy (CRT)

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Pros and cons of

Cardiac Resynchronization Therapy (CRT)

Pros

1. Alleviates the symptoms of congestive heart failure, which is when the heart beats more weakly than normal, preventing adequate blood from being pumped to the different parts of the body. The pacemaker will help the lower chamber of the hearts beat more efficiently in rhythm with each other.

2. Improves survival, quality of life, heart function, and the ability to exercise.

3. Reduces hospital stays in patients with severe congestive heart failure

Cons

N/A

How It Works:

Cardiac Resynchronization Therapy (CRT)

The patient will receive intravenous fluids and medication. During the procedure the patient’s vital signs and blood pressure will be monitored. The patient will be given a sedative and/or anesthesia from the anesthesiologist so they are asleep during the procedure. A local anesthetic will be administered before the lead (or leads) is placed. This is a small wire that is inserted into a major vein near your collarbone. Leads are attached to the muscles of the heart in the appropriate locations and are connected to the pulse generator. When the device is placed the doctor will program it to stimulate the heart as appropriate for the patient. The placement of the cardiac resynchronization therapy (CRT) device takes approximately two to four hours.

Preparation before

Cardiac Resynchronization Therapy (CRT)

Pre - treatment

It is recommened that you avoid food and water for at least eight hours before the procedure. Be sure to discuss with your doctor about all medication that you are taking as some may need to be stopped before the procedure.

Recovery after

Cardiac Resynchronization Therapy (CRT)

Post - treatment

1.The patient will be moved to the Cardiac Care Unit (CCU) for one night for close observation and then will be moved to a regular inpatient room for an additional one to two nights to ensure that the cardiac resynchronization therapy (CRT) device is working properly.

2. You may experience some pain and swelling in the area where the device was placed.

3. You will be asked to avoid raising the arm above the shoulder on the side of the cardiac resynchronization therapy (CRT) implantation, strenuous activity and heavy lifting for about one month after the surgery.

4. During your regular check-ups, your doctor will check the battery in your device, which should last up to 5-10 years, depending on how much it is used. The replacement of batteries is done much more easily than the initial placement of the device.

Risks & side effects

-Bleeding or hematoma, and infection where the cardiac resynchronization therapy (CRT) device was implanted.

-Allergic reaction to the medications used during the procedure.

-Damage to blood vessels.

-Collapsed lung.

-Bleeding in the pericardium.

-Stroke, heart attack, or other serious complications, which are uncommon.

FAQs:

Cardiac Resynchronization Therapy (CRT)

Who is a candidate for CRT?

In general, CRT is for heart failure patients with moderate to severe symptoms and whose left and right heart chambers do not beat in unison. However, CRT is not effective for everyone and is not for those with mild heart failure symptoms, diastolic heart failure or who do not have issues with the chambers not beating together. It is also not suitable for patients who have not fully explored correcting the condition through medication therapies. To date, studies show CRT to be equally effective for both men and women.

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How does it feel to receive a shock with CRT-D?

Patients say that getting shocked is like “being kicked in the chest.” Some patients pass out before they are shocked and do not remember being shocked. Before a shock is delivered, the CRT-D will try to correct your dangerous heart rhythm.

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What is the difference between CRT-P and CRT-D?

Cardiac resynchronization therapy with a pacemaker (CRT-P) - The device used for cardiac resynchronization therapy has three leads that connect the pacemaker to the right upper chamber of your heart (right atria) and both lower chambers (ventricles). Cardiac resynchronization therapy with a pacemaker and an ICD (CRT-D) - This device may be recommended for people with heart failure who also have a risk of sudden cardiac death. It can detect dangerous heart rhythms and deliver a stronger shock of energy, which is able to reset your heartbeat, than a pacemaker can deliver.

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