Cardiac Resynchronization Therapy

Cardiac resynchronization therapy (also called CRT or biventricular pacing) is a procedure that makes your ventricles beat together. You may need this if you have heart failure and your ventricles beat out of sync. When both ventricles (lower heart chambers) beat at the same time, it’s easier for your heart to pump blood.

In CRT, your healthcare provider puts a biventricular pacemaker in your chest. This is a pacemaker with an extra wire. Your cardiologist may suggest this option after you try medicine and lifestyle changes.

Heart resynchronization therapy is fairly common. People with a heart rhythm problem, like left bundle branch block, may have it. But it still comes with risks.

How does cardiac resynchronization therapy work?

Unlike other pacemakers that have one or two wires or leads, a CRT pacemaker (CRT-P) has three. One lead goes to each of your ventricles. The third goes to your right atrium, one of your heart’s upper chambers. (Your heart has two ventricles and two atria.)

With a cardiac resynchronization therapy device, three leads can send a signal. This makes your heart chambers work together and corrects your heart rhythm. Signals come from electrodes that a provider places in your heart muscle.

How should I prepare for cardiac resynchronization therapy?

Your healthcare provider will:

• Order imaging, like a heart MRI or an echocardiogram. This may happen days before you get your CRT device. You may also have blood tests.
• Ask you to fast (not eat or drink) for at least six hours before the procedure.
• Give you medicine so you won’t feel pain or be aware of what’s happening.

What happens during this procedure?

During cardiac resynchronization therapy, your healthcare provider will:

1. Insert three wires through your veins in your upper body or thigh.
2. Thread the wires through your veins to your heart.
3. Make a cut for the CRT device below your collarbone or in your belly.
4. Connect the wires to your CRT pacemaker.
5. Make sure the device works.
6. Implant the CRT device under your skin.
7. Stitch up your cut (incision).

This biventricular pacing procedure takes several hours.

What are the potential benefits and risks of heart resynchronization therapy?

CRT treatment may give you these benefits:

• Help your heart pump more blood out to your body.
• Make your heart more efficient.
• Help improve symptoms like shortness of breath.
• Cut down your risk of abnormal heart rhythms in your ventricles.
• Help you live longer with heart failure.
• Improve mitral valve regurgitation (a leak in your heart’s mitral valve).
• Help you to be more physically active.

Possible complications of cardiac resynchronization therapy include:

• Wires breaking or moving out of place
• Infection
• Bleeding
• Blood clots
• Allergic reaction
• Heart attack or another heart issue
• Collapsed lung

What happens after this procedure?

After you receive a cardiac resynchronization therapy device:

• You may need to stay a few hours or overnight in the hospital.
• You’ll need someone to drive you home because you had anesthesia.
• You’ll need to keep your left arm still for about 12 hours to help the leads stay in place.
• You’ll get a card to keep with you that has details about the device you have.
• A healthcare provider might check your leads with an X-ray or your heart rhythm with an EKG.
• They may test your device to see if it can send data.

What is the recovery time?

After heart resynchronization therapy, you can go back to your normal activities in a few days. You shouldn’t drive or lift heavy things for a week or so.

Your CRT pacemaker should last for several years. It should improve your quality of life. Cardiac rehab can help you handle more physical activity after this procedure.

When should I call my healthcare provider?

Contact your provider if you get a fever weeks or months after getting a CRT pacemaker. It could mean you have an infection around your device.

You’ll have a follow-up visit a month after you get your CRT pacemaker. Then, you’ll see your provider once or twice a year.

Your provider will check your pacemaker remotely from their office. But they’ll still need to see you at times. They need to be sure your device, battery and wires are in good shape. They can also do testing to see if the device is helping your heart work better.

Does cardiac resynchronization therapy work?

The success rate for the procedure itself is high. But researchers estimate that CRT doesn’t help 2 to 3 out of 10 people who receive it.

What is the difference between ICD and CRT?

An ICD (defibrillator) gets a fast rhythm back to normal. It helps people who have dangerous heart rhythms in their ventricles.

Cardiac resynchronization therapy uses a biventricular pacemaker (CRT-P) to make your ventricles work together.

Many people may need a biventricular pacemaker with an ICD (CRT-D) to correct all of these issues.