Cardiac Resynchronization

Therapy – Treats Abnormal Heart  Rhythms

 

What is Cardiac Resynchronization Therapy?

Some patients with heart failure have a delay in contraction between the two ventricles, which impairs the pumping activity of the heart.  Cardiac Resynchronization Therapy (CRT) is prescribed to improve abnormal heart rhythms in patients with heart failure, and help the heart chambers to pump out blood more efficiently and in a coordinated manner. CRT involves implanting a Biventricular Pacemaker, which 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.

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 What is a Biventricular Pacemaker?

The CRT Device, or the Biventricular Pacemaker, is used for Cardiac Resynchronization Therapy. It is a tiny device which 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) are connected to the pulse generator. The pulse generator is placed under the skin in either the upper chest or the abdomen.

 When is Cardiac Resynchronization Therapy (CRT) recommended?

CRT is usually prescribed for the following conditions:

  • Severe congestive heart failure
  • Cardiomyopathy (diseases of the heart muscles)
  • Significant rhythm abnormalities affecting the lower chambers of the heart (bundle branch block)
  • In patients with heart failure, CRT is prescribed to improve heart function, quality of life, ability to exercise, and survival, especially in patients who are not responding to medications.

Before the procedure:

The Physician might carry out the following diagnostic tests to determine whether you require a CRT:

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

The patient undergoing CRT should not eat anything for 8 hours before the procedure.

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During the procedure:

Cardiac Resynchronization Therapy is a minor surgery which takes around 3 to 5 hours.

The following steps are taken in this procedure:

  • 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.

After the procedure:

After the surgery, the patient has to stay in the hospital for a day. The patient needs to restrict arm movements to prevent breaking of the incision. 

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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

Complications that need immediate medical attention

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

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