Will I be awake?
A medication will be given through your IV to relax you and make you feel drowsy, but you will not be asleep during the procedure (with the endocardial approach).
Will I be monitored?
The nurse will connect you to several monitors that allow the health care team to check your heart rhythm and blood pressure during the procedure. The nurse continually monitors you during the procedure.
Monitors During the Procedure
- Defibrillator/pacemaker/cardioverter: Attached to one sticky patch placed on the center of your back and one on your chest. This allows the doctor and nurse to pace your heart rate if it is too slow, or deliver energy to your heart if the rate is too fast.
- Electrocardiogram or EKG: Attached to several sticky electrode patches placed on your chest, as well as inside your heart. Provides a picture on the monitors of the electrical impulses traveling through the heart.
- Blood pressure monitor: Connected to a blood pressure cuff on your arm. Checks your blood pressure throughout the procedure.
- Oximeter monitor: Attached to a small clip placed on your finger. Checks the oxygen level of your blood.
- Fluoroscopy: A large X- ray machine will be positioned above you to help the doctors see the leads on an X-ray screen during the procedure.
How is the device implanted?
- The CRT device can be implanted using the endocardial or epicardial approach.
- With the endocardial (transvenous) approach, a local anesthetic (pain- relieving medication) is injected to numb the area, and you will be awake during the procedure.
- Small incisions are made in the chest where the leads and device are inserted. The leads are inserted through the incision and into a vein, then guided to the heart with the aid of the fluoroscopy machine. Two leads are guided to the right atrium and right ventricle, while the third lead is guided through the coronary sinus to the left ventricle. The lead tips are attached to the heart muscle, while the other ends of the leads are attached to the pulse generator. The generator is placed in a pocket created under the skin in the upper chest.
- When the endocardial approach is used, the hospital recovery time is generally 24 hours.
- The endocardial technique is technically challenging. In some cases, this technique may not be successful due to the size, shape or location of the vein(s). If the endocardial approach cannot be used or is unsuccessful, the epicardial approach will be used.
- The epicardial approach may also be used to place the CRT if you are already having surgery to treat another heart condition.
- With the epicardial (surgical) approach, general anesthesia is given to put you to sleep during the procedure. The leads are guided to the heart with the aid of the fluoroscopy machine. Two leads are guided to the right atrium and right ventricle, while the third lead is guided through the coronary sinus to the left ventricle. The lead tips are attached to the heart muscle, while the other ends of the leads are attached to the pulse generator. The generator is placed in a pocket created under the skin in the lower abdomen.
- The hospital recovery time is generally 3 to 5 days. Although recovery with the epicardial approach is longer than that of the transvenous approach, minimally invasive techniques enable a shorter hospital stay and quicker recovery time. Your doctor will determine the best implant procedure approach for you, depending on your condition.
How are the leads tested?
After the leads are in place, they are tested to make sure lead placement is correct, the leads are functioning properly and the right and ventricle are synchronized. This lead function test is called “pacing.” Small amounts of energy are delivered through the leads into the heart muscle. This energy causes the heart to contract. You will be asleep for several minutes during the lead function test. Once the leads have been tested, the doctor will connect them to the device. The rate and settings of your CRT device are determined by your doctor. After the implant procedure, the doctor uses an external device (programmer) to program final device settings.
What will I feel?
With the endocardial approach: You will feel an initial burning or pinching sensation when the doctor injects the local numbing medication. Soon the area will become numb. You may feel a pulling sensation as the doctor makes a pocket in the tissue under your skin for the device. Please tell your doctor what symptoms you are feeling. You should not feel pain. If you do, tell your nurse right away.
With the epicardial (surgical) approach: You will be given anesthesia to put you asleep during the procedure, so you will not feel anything.
With both approaches, you may feel discomfort at the implant site during the first 48 hours after the procedure. The doctor will tell you what what medications you can take for pain relief. Please tell your doctor or nurse if your symptoms are prolonged or severe.
How long does the procedure last?
The device implant procedure may last from 2 to 5 hours.