Cardiac Resynchronisation Therapy (CRT)
What is Cardiac Resynchronisation Therapy (CRT)?
A Cardiac Resynchronisation Therapy (CRT) Device is an implantable cardiac device specifically designed for people with heart failure. Cardiac Resynchronisation Therapy is an advanced form of electrical pacing, in a coordinated contraction of the heart ventricles for patients who have a type of electrical conduction system disease known as Left Bundle Branch Block. This synchronised contraction can improve the efficiency of damaged or weakened heart muscle in this groups of patients. Cardiac Resynchronisation Therapy is also commonly known as Biventricular Pacing.
Cardiac Resynchronisation Therapy technology can be built into either pacemakers and defibrillators. Depending on the clinical reason for device implant, a patient with heart failure and left bundle branch block may be offered either a Cardiac Resynchronisation Therapy Pacemaker or a Cardiac Resynchronisation Therapy Defibrillator. Your cardiologist will explain the difference in the indications for these devices.
How do I Prepare?
Before the Procedure
- Your doctor will advise you if any medication needs to be ceased prior to the procedure.
- You will be required to fast for 6 hours prior to the procedure.
- Some patients may be required to have their chest shaved.
- You will have a cannula inserted into your arm vein and connected to a drip.
- You will be given preoperative IV antibiotic to reduce the risk of the device becoming infected.
What Should I Expect?
During the Procedure
- At the beginning of the procedure, you will be given medication to help you relax. This may either be a sedative or an anaesthetic.
- Local anaesthetic is injected under the skin to numb the area in the region of the left or right upper chest a few centimetres below the collarbone. The local anaesthetic will take away your pain sensation, though it is normal to still feel some pushing and pulling.
- An incision will be made in the skin to create a pocket for the device, below your collarbone.
- The pacing leads are inserted in place, from the pocket, through your vessels under your collarbone and into the heart.
- The leads are secured in place in the heart and tested to check that they are working well.
- The pulse generator is connected to the leads, and then inserted into the pocket under the skin. The skin is closed using sutures (stitches).
- A sterile waterproof dressing will cover the site.
- The procedure normally takes 2-3 hours.
After the Procedure
- You will most likely need to stay in hospital overnight after the procedure.
- You will have continuous ECG monitoring while you are in hospital.
- You may need some pain relief medication. Pain after a pacemaker insertion is usually mild and often controlled with paracetamol.
- Before leaving the hospital, a cardiac scientist will check your device to make sure it is working properly and confirm with the Electrophysiologist. Any issues identified will be corrected before you are discharged from hospital.
- Most people will be discharged from hospital the following day.
- You will receive some information about how long to keep your waterproof dressing on over your device implant site.
- You will not need to have any stitches removed because they are buried below the skin and are dissolvable.
- You will receive a cardiac device identification card along with an information booklet produced by the manufacturer of your device.
- You will also receive information about how to get your cardiac device connected to your remote transmitter.
- Your doctor will advise you on your follow up appointments prior to discharge.
- It is common to leave hospital feeling emotionally and physically drained. This will improve as you recover. Most people adapt very well to living with their implanted cardiac device and return to most of their previous activities.
Returning to Daily Life
- Driving: Austroads Assessing Fitness to Drive 2016 Guidelines advise no driving for 2 weeks following a CRT Device implant. There are additional driving guideline restrictions for those patients who have received an ICD implant following a cardiac arrest – please ask your doctor.
- Exercise: You may walk for gentle exercise the day after you get home from hospital.
- Returning to work: For sedentary work you may only need a few days off work. For physical jobs, depending on what is required, you may need a week off work.
- Restricted Arm Movements: You will be given information about arm movement restrictions for the arm on the side of the implant – generally doctors advise to avoid lifting the arm above should height for a period of time. Check with your doctor on your specific recommendations.
- Household Appliances: You can safely use all common household appliances including microwaves, televisions, computers etc.
- Mobile Phones: Avoid putting a mobile phone in a shirt breast pocket in close contact with your device.
- The response to Cardiac Resynchronisation Therapy varies between patients. Improvement can be slow, and it generally takes at least a few months. You will hopefully notice improvement in your ability to exercise, a decrease in shortness of breath and heart failure symptoms and an improvement in quality of life.
- Cardiac Resynchronisation Therapy helps to treat heart failure but does not replace the medications that also treat heart failure. Please continue to take your medications as directed.
- Your friends and family should be encouraged to learn about your Cardiac Resynchronisation Therapy device and how they can continue to support you at home. Your device can be a source of security for you and your family.
Future Medical Procedures
- Always tell any your health professional that you have a cardiac device implanted and if needed, show your Cardiac Device ID card.
- MRI Scans: Most cardiac devices are now MRI compatible. If you need an MRI scan please contact us to obtain an MRI compatibility checklist to submit to the radiology company.
- Most medical procedures are unlikely to interfere with your device, except some MRI scanners. In fact, having a cardiac device implant that keeps your heart rate stable can make your medical or surgical procedure safer.
Follow up Appointments and Device Checks
- Follow-up arrangements can vary between doctors. Generally, an annual check is scheduled in the clinic and a remote monitoring check is also performed during the year.
- Your cardiac device is checked for its records of your heart rhythm, the effectiveness of its therapy and for battery life. Most device batteries are expected to last approximately 10 years.
- Your cardiac device will be programmed appropriately at implant according to your heart rhythm issue; however, this might require adjustment as time goes by. Cardiac device programming is always reviewed routinely at clinic and via remote transmission follow-up.
- On any given day, an alert might be received from the cardiac device via the remote transmitter. The cardiologist or cardiac device technician may contact you to discuss an issue and/or arrange for you to attend clinic to address an issue.
Remote Monitoring Service
- QCG offers a remote monitoring service that enables ‘virtual check-ups’ for your implanted cardiac device. Your device is able to directly and securely transmit data from your device to your Cardiologist from the comfort of your own home.
- This enables us to detect significant events such as an abnormal heart rhythm, monitor the performance of your device such as battery life, and optimise your care through device programming or medication change.
- Remote monitoring takes the form of a scheduled check-up once a year where all of the device data is reviewed. We also respond to alerts generated and transmitted by the cardiac device on any given day, if an event or issue is detected.