Irregular heartbeat? Let's talk about CRT treatment (Cardiac Resynchronization Therapy)

Think of your heart as a musical ensemble. When everyone is working in unison, at the same time, beautiful music is created. But sometimes, especially with conditions like heart failure, the two lower chambers of the heart, the ventricles, start working in opposition to each other, out of sync. When one beats, the other doesn't, and when the other beats, it doesn't. When the two chambers of the heart are pulled apart, the heart can't pump blood properly. That's when a special treatment called Cardiac Resynchronization Therapy, or CRT for short, comes to our aid.

Simply put, what is this CRT?

CRT is a treatment that restores the heart's rhythm to normal. It is also called Biventricular Pacing. "Biventricular" means "both chambers." This means that this treatment causes the two lower chambers (ventricles) of the heart to beat together at the same time. To do this, your doctor will implant a small device under the skin of your chest.

This is a little different from a regular pacemaker. A regular pacemaker has one or two wires. But this CRT device has three wires . These three wires are connected to three specific places in the heart.

• One wire goes to the upper chamber of the heart (right atrium)
• The second wire goes to the lower right chamber of the heart (right ventricle).
• The third wire goes to the lower left chamber of the heart (left ventricle).

These three wires send very subtle electrical signals, causing the heart's chambers to work together, in unison. It's like a conductor sitting in front of an orchestra and giving everyone the signal to play together. This greatly increases the heart's pumping efficiency.

Who really needs this CRT treatment?

This treatment is not for everyone. Your doctor will look at several factors before recommending it.

• Heart Failure Status: Checks whether you have moderate or severe heart failure.
• Drug treatment: Even after using the best medications for heart failure, symptoms (shortness of breath, fatigue) are still seen.
• Heart rhythm problems: An ECG test looks for a delay in the transmission of electrical signals in your heart. This is often recommended, especially for people with a condition like Left Bundle Branch Block .
• Heart pumping ability: An echocardiogram (heart scan) will also check if your heart's blood pumping ability (ejection fraction) is low.

Simply put, doctors consider this treatment for people who have an irregular heartbeat that is difficult to control with medication and lifestyle changes.

How do you prepare before treatment?

Since this is a minor surgery, you need to prepare for it beforehand. Your doctor will tell you to do the following:

• Tests: A few days before surgery, you will be asked to have an echocardiogram , possibly an MRI scan of the heart , and some blood tests to determine the exact condition of your heart.
• Fasting: You will be advised not to eat or drink anything for at least 6 hours before surgery.
• Medication: During the surgery, you will be given medication to numb your pain and put you into a light sleep, so you won't feel anything.

How is the surgery performed?

This process takes several hours. Here's what happens:

1. Inserting the wires: First, the doctor inserts three very thin wires through a vein in your shoulder, or possibly your thigh. This is done very carefully while watching an X-ray machine.

2. Sending the wires to the heart: These wires are then passed through the veins and placed in the three designated locations of the heart discussed earlier (right atrium, right ventricle, and left ventricle).

3. Making a space for the device: Next, a small incision is made in the skin below your collarbone, creating a small space (pocket) under the skin. This is where the CRT device will be placed.

4. Connection and testing: The other ends of the three wires sent to the heart are connected to this CRT device. Then, they check to see if it is working properly and if the signals are going through properly.

5. Implantation of the device: If everything is OK, the CRT device is placed inside the created pocket, the incision is closed, and stitches are placed neatly.

What are the benefits and risks of this treatment?

Like any medical treatment, CRT has both benefits and risks. It is important to discuss these carefully with your doctor.

What happens after treatment?

You will need to stay in the hospital for about a day after the surgery.

• On the way home: Since you have been given sleeping pills, you will not be able to drive a vehicle . Therefore, it is essential to bring someone to take you home.
• Arm movement: The arm on the side where the device was implanted (usually the left arm) should be kept still and not lifted for about 12 hours . This allows the inserted wires to settle properly in the heart.
• Special Card: You will be given a special card, which has all the details of this device on it. It is very important to keep this card in your wallet at all times.
• Recovery: You can resume normal activities within a few days, but it is not recommended to drive or lift heavy objects for about a week.
• Recheck: Before you are sent home, an X-ray or ECG may be taken to check that the wires are in place.

What is the difference between CRT and ICD?

This is something that confuses many people. CRT and ICD are two types of devices.

• CRT (Cardiac Resynchronization Therapy): As we've discussed, this is used to synchronize the heartbeat. That is, it makes the heart's chambers work together, in one rhythm. It's an advanced version of a pacemaker.
• ICD (Implantable Cardioverter-Defibrillator): This does something different. If the heart is beating dangerously fast, it recognizes it and delivers a small electric shock to restore it to normal . This is a life-saving device.

But often, people with heart disease can have both of these problems. That's why doctors implant a single device that has both capabilities, a CRT-D (CRT with Defibrillator) .

When to talk to the doctor

After you have a CRT device implanted, there are certain things you need to be careful of.

In addition, you must attend the scheduled clinic dates.

• The first follow-up will be held about a month after surgery.
• After that, they will ask to see you once or twice a year.

At these clinics, the doctor checks the condition of the device, its battery, and the wires. He also checks how much your heart function has improved due to this device.