Are you aware of CRT (Cardiac Resynchronization Therapy), which causes the heart's chambers to beat together?

Do you sometimes feel tired for no reason, or have difficulty breathing when climbing stairs? Perhaps your doctor has told you that your heart is working a little weakly, which means that you have a condition called 'Heart Failure'. The main thing that happens in such cases is that the chambers of the heart do not beat at the same time and in the same rhythm. Due to this, the heart cannot pump the blood needed by the body properly. This is the solution to this problem that we are talking about today, this special treatment called CRT.

Simply put, what is this CRT treatment?

CRT is an abbreviation for 'Cardiac Resynchronization Therapy'. To be precise, this is a procedure in which a special pacemaker is implanted into the heart through a minor surgical procedure. Another name for this is 'biventricular pacing'.

Imagine, our heart has two lower chambers, which we medically call ventricles . In a healthy heart, both of these chambers should contract together, at the same time, to pump blood to the body. But in conditions like heart failure, these two chambers contract at different times. This is called 'dyssynchrony.' At that time, what this CRT device does is send small electrical signals to make both of these chambers beat at the same time, in the same rhythm. That is, it resynchronizes the heartbeat.

How does this CRT device work?

You've probably heard of regular pacemakers. They have one or two leads. But this CRT pacemaker has three leads . This is what's special.

Imagine, one of these three wires is connected to the right ventricle of the heart, and the other to the left ventricle. The third wire is connected to the right atrium, which is a chamber at the top of the heart. So, the rhythm of the heart is constantly monitored through these three wires. If an abnormality in the rhythm is seen, that is, if the chambers are not beating together, this device sends a small electrical signal at the right time and makes those chambers work together. It is like a conductor of an orchestra, controlling everyone to one rhythm.

What is the difference between CRT and ICD?

You may have also heard of a device called an ICD. Don't confuse the two. These two perform two functions. Let's understand this with a table.

But there is something else. Some patients may have both of these problems. That is, the heart chambers do not beat together, and dangerously fast rhythms occur. For such people, doctors recommend installing a combination of these two devices (CRT-D device) .

Who needs this treatment?

Typically, people with irregular heart rhythms (arrhythmias) need this type of pacemaker. However, CRT therapy is specifically recommended for people who meet certain criteria. There can be several reasons why the heart may be weak or have an irregular rhythm.

• Heart Failure: The heart is unable to pump enough blood to the body.
• Heart damage due to a previous heart attack .
• Heart function declines with age.
• Because of some medications.
• Congenital heart disease .
• Disturbances in the transmission of electrical signals in the heart. For example, a condition called 'Bundle Branch Block' .

How the surgery is performed

What happens before surgery?

A few days before surgery, your doctor will order several tests to check the function and structure of your heart. For example, you may be asked to have an MRI scan of the heart or a Transthoracic Echocardiogram (TTE) . You will be given anesthesia to prevent you from feeling any pain during the surgery. You may also be put to sleep.

During surgery...

1. First, the doctor inserts three special wires into specific locations in your heart, either through a vein in your shoulder or perhaps your thigh.

2. Next, a small incision is made in the skin below the shoulder to create a small pocket to hold the pacemaker device (a small box containing the battery and circuitry).

3. Then the wires sent to the heart are connected to this device and checked to see if it is working properly.

4. If everything is OK, the device is placed inside the created pocket, and the skin incision is closed with dissolvable stitches.

What happens after surgery?

• You will need to stay in the hospital for a few hours or overnight.
• Since you've been anesthetized, don't drive home. You'll need to go with someone else.
• They tell you to keep your left arm from moving too much for about 12 hours after the surgery until the wires settle into place.
• You will be given a special card. It contains details about the device that was implanted in you. It is very important to keep this card with you at all times . This is required in places like airports.
• You may need to take an X-ray to make sure the wires are in the right place, or you may need to do an EKG (electrocardiogram) to check your heart rhythm.

Benefits and risks of CRT treatment

Benefits of treatment

If this treatment is successful, your quality of life could improve greatly.

• The amount of blood pumped by the heart to the body increases.
• The efficiency of the heart increases.
• Symptoms such as shortness of breath and fatigue decrease.
• Reduces the risk of abnormal heart rhythms.
• The time to live may increase.
• Even conditions such as Mitral Regurgitation, where blood flows backward through a heart valve, can improve.
• Exercise ability improves.

Isn't there a risk in this?

• Installed wires break or move out of place.
• Infection at the surgical site.
• Blood clots.
• Allergic reactions to anesthetics or anything else.
• Having another heart problem, such as a heart attack (very rare).

Recovery and seeking medical advice

You can resume normal activities within a few days after surgery. However, doctors advise you not to do anything like driving or lifting weights for a week or two . The battery in this implanted pacemaker usually lasts for about 7-10 years. When the battery becomes weak, it can be replaced with another minor surgery.

When should you see a doctor?

You will have a follow-up appointment about a month after surgery. After that, you will have to see the doctor once or twice a year. They will check the device, battery, and wires on a computer to make sure they are working properly.

Very important: If you develop a fever, or if the area where the device was inserted becomes red, swollen, or painful, weeks or months after surgery, call your doctor immediately. This could be a sign of an infection.

Cardiac resynchronization therapy, CRT therapy, pacemaker, biventricular pacing, heart failure, heart rhythm