Are you always feeling tired and short of breath? Learn how Cardiac Resynchronization Therapy (CRT) helps your heart beat in sync again.

Do you often feel tired for no clear reason? Do you find it hard to catch your breath when you climb a flight of stairs?

Your doctor might tell you that your heart is not pumping as well as it should. This condition is often known as heart failure.

When you have heart failure, a major problem can occur. The chambers of your heart stop beating together at the exact same time. This lack of teamwork makes it very hard for your heart to push blood out to the rest of your body.

To fix this problem, doctors use a special treatment called Cardiac Resynchronization Therapy, or CRT. This complete guide will walk you through everything you need to know about how CRT works, what the surgery involves, and how it can help you live a better life.

Figure 1: Diagram showing a cardiac device with leads connected to the heart chambers to restore normal rhythm.

Simply Put, What is CRT Treatment?

CRT stands for Cardiac Resynchronization Therapy. Put simply, it is a special kind of pacemaker placed inside your chest through a minor surgical procedure. Another name for this approach is biventricular pacing.

Think about how your heart works. It has two lower chambers called ventricles. In a healthy heart, these two chambers squeeze together at the exact same moment to push blood forward.

When you have heart failure, these lower chambers squeeze at different times. Doctors call this problem dyssynchrony. Because the timing is off, your heart wastes energy and fails to supply enough blood to your organs.

A CRT device sends tiny, gentle electrical signals to both ventricles. These signals force the chambers to contract together at the right time. In short, it brings your heartbeat back into a smooth, healthy rhythm.

How Does the CRT Device Work?

You may already know about standard pacemakers. Those devices usually have only one or two wires, which doctors call leads. However, a CRT pacemaker features three separate wires, making it unique and powerful.

The first wire connects to the right lower chamber of your heart. The second wire wraps around to connect to the left lower chamber. The third wire connects to the upper right chamber of your heart.

These three wires constantly monitor your natural heart rhythm. If the device spots any timing delay where your lower chambers fail to beat together, it acts right away. It sends a small electrical pulse down the wires to coordinate the squeeze.

You can think of the device as the conductor of an orchestra. Just as a conductor keeps every musician playing in time, the CRT device keeps your heart chambers working together in perfect harmony.

What is the Difference Between CRT and ICD?

You might also hear about another device called an ICD. It is important not to confuse the two, because they perform very different jobs in your body.

Let us look at how they compare using a simple table:

Sometimes, a patient suffers from both problems. They might have chambers that do not beat together, along with a risk of dangerous fast rhythms. For these people, doctors recommend a combination device known as a CRT-D.

Who Needs This Treatment?

Standard pacemakers are usually given to people with an irregular heart rhythm or arrhythmia. However, doctors recommend CRT treatment only for patients who meet specific medical criteria.

Heart weakness and rhythm problems can develop for several reasons:

• Heart failure, where your heart cannot pump blood well enough.
• Previous heart attacks that left scar tissue on the heart muscle.
• Normal aging that weakens the heart over time.
• Damage caused by certain strong medicines.
• Congenital heart disease present since birth.
• Blockages in the electrical pathways of your heart, such as bundle branch block.

Remember that doctors try medicines and lifestyle changes first. If those steps do not control your symptoms, they will consider CRT treatment. Only your cardiologist can decide if this option is right for you.

How the Surgery Takes Place

Before the Procedure

In the days before your surgery, your doctor will order a few tests to check your heart structure and function. These may include an electrocardiogram, blood tests, or an echocardiogram.

On the day of the procedure, you will receive medicine to keep you comfortable and pain-free. Depending on your health needs, your care team may give you light sedation or put you to sleep entirely.

During the Procedure

First, the doctor guides the three special wires through a blood vessel near your collarbone down into the correct spots inside your heart.

Next, the surgeon makes a small cut just beneath your skin near your collarbone. They create a tiny pocket to hold the pacemaker device, which contains the battery and computer chips.

After that, the doctor attaches the wires to the device and tests everything carefully to ensure the electrical signals flow properly.

Once tests confirm the device works well, the surgeon places it inside the pocket and closes your skin using dissolvable stitches.

After the Procedure

• You will need to stay in the hospital for a few hours or overnight for monitoring.
• Because you received medicine to help you relax, you cannot drive home. Arrange for a trusted family member or friend to drive you.
• To let the wires settle safely into place, your doctor will ask you to limit movement in your left arm for about 12 hours.
• Your care team will give you a special device identification card. Keep this card with you at all times because airport security and medical staff need to see it.
• Your doctors may take a chest X-ray and an EKG to verify that your heart rhythm is steady and the wires remain secure.

Benefits and Risks of CRT Treatment

Benefits of the Treatment

When this treatment succeeds, your daily quality of life can improve dramatically.

• Your heart pumps more blood with every single beat.
• Your overall heart efficiency increases greatly.
• Troublesome symptoms like tiredness and shortness of breath fade away.
• The risk of dangerous irregular heart rhythms drops.
• Your life expectancy and survival rates improve.
• Valve issues, such as mitral regurgitation, often improve because the heart chambers close correctly.
• You gain more energy to enjoy physical activities and hobbies.

Are There Risks?

Just like any surgical procedure, CRT carries some risks. However, serious complications happen very rarely. Your doctor will discuss these potential risks with you before your surgery.

• Wires can sometimes shift out of place or break.
• An infection can develop around the incision site.
• Blood clots may form near the procedure area.
• You might experience an allergic reaction to medicines used during surgery.
• Rarely, the procedure can trigger another heart issue, such as a heart attack.

Recovery and Medical Follow-Up

You can usually return to your normal daily routine within a few days after surgery. However, doctors advise that you avoid driving or lifting heavy objects for one to two weeks.

The battery inside your CRT device usually lasts between seven and ten years. When the battery runs low, a simple minor procedure lets your doctor replace the device.

When Should You See a Doctor?

Your doctor will schedule a follow-up appointment about a month after your procedure. After that, you will visit the clinic once or twice a year so the medical team can check your device and battery using a special computer monitor.

Very Important: If you develop a fever weeks or months after surgery, or if the skin near your device becomes red, swollen, or painful, contact your doctor right away. These signs can point to an infection.