The term cardiac resynchronization therapy is synonymous with biventricular pacemaker. In cases of advanced heart failure, wherein the heart’s ventricles or right chambers are not working well, cardiac resynchronization therapy (CRT) or biventricular pacing is utilized. It is an innovative therapy that can reduce heart failure symptoms. Heart failure means the heart is unable to pump as it should. With heart failure, blood accumulates in the heart itself and is unable to move through the heart and body, as it should. This results in increasing pressure on the heart. Heart failure simply put, is biventricular failure, wherein they do not contract simultaneously. The pacing device for this Cardiac Resynchronization Therapy (CRT) is known as the biventricular pacemaker.
When are you recommended a biventricular pacemaker ?
Cardiac resynchronization therapy (CRT) will be considered for people who have severe or moderately severe heart failure symptoms, are taking medications to treat heart failure, have bundle branch block, with a history of cardiac arrest or are at possible risk for it. It is recommended in people with heart failure who have a poor ejection fraction (less than 35%) are at risk for fast, irregular and life- threatening heart rhythms. What we mean by ejection fraction is the measurement of exactly how much blood is being pumped out of the heart in order to be supplied to the body. Cardiac resynchronization therapy definitely improves symptoms, survival, cardiac functions and the exercising capability in patients with severe or moderately severe heart failure, who are not responding so well to medicinal therapy.
How does cardiac resynchronization therapy or a biventricular pacemaker work ?
The CRT pacing device (known as a biventricular pacemaker) is an electronic, battery-driven appliance that is to be implanted right under the skin, below the collarbone, surgically. This device can pace, sense and defibrillate all together. When your heart rate drops below normal, the device generates or fires diminutive electrical impulses that are conducted through the leads, and travel to the cardiac muscle. These electrical impulses make the lower chambers (ventricles) of the heart muscle contract, bringing about the synchronous action of the right and left ventricles pumping together. The end result is improved cardiac function.
How is a biventricular pacemaker implanted ?
A medication will be given through your IV to relax you and make you feel calmer, but you will be awake for the duration of the procedure (with the endocardial approach). The epicardial approach is done under general anesthesia. The implanting of the device might take anything between 2 to 5 hours. With the endocardial (transvenous) approach, the site is cleaned, a local anesthetic is injected and the surgical incision is made in the chest. The parts of the biventricular pacemaker are then inserted- the leads and the generator device. The leads are guided into the incision site, into a vein, and finally the cardiac chamber with the aid of the fluoroscopy machine. Two leads will be placed in both the right atrium and the right ventricle, whilst the third lead is guided through the coronary sinus to the left ventricle. One end of the pacemaker is at the lead tips, touching the heart muscle; whilst the other end of the pacemaker is attached to the pulse generator. The generator is placed right under the skin in the upper chest. Compared with the conventional pacemakers, which have only two leads, the first lead in the right atrium and the second one in the right ventricle, implantation of a biventricular pacemaker involves an added lead (a third lead) in a coronary vein and thus result in an increased potential for complications.
What are the complications of cardiac resynchronization therapy ?
The most common causes of failure of biventricular pacing include failure to position implant, implant failure, lead or wire dislodgement from actual site, and atrial tachyarrythmias. Some more complications can be seen & are similar to that of routine pacemakers, such as pneumothorax, perforation of the heart in surgery, creation of an air embolus, infection, bleeding and arrhythmias.
What is to be expected post cardiac resynchronization therapy ?
As a patient, usually you have to remain in the hospital overnight and are to be discharged the following day. A chest X-ray will be performed to verify the position of the pacemaker and leads. A final pacemaker check is also completed. Discharge instructions are for good wound care, limited activity guidelines, changes to their medications and follow-up care. Keep the insertion site clean and dry, inspect it daily, and report any signs of infection to your physician. Keep a track of your physical activity. Exercise should be avoided for at least 6 weeks post the procedure.
What treatment regimen should you follow after cardiac resynchronization therapy ?
A total check will be done on your pacemaker, after 6 weeks of the procedure, either in the physician’s office or at a clinic. In addition to the initial pacemaker follow-up, you will need to be followed regularly to ensure that the pacemaker is functioning properly. CRT isn’t meant to replace the other medical therapies prescribed for heart failure. You still need to follow their pharmacologic and nonpharmacologic treatment program.
What are you supposed to be avoiding post cardiac resynchronization therapy ?
Electromagnetic interference can impede the function of the pacemaker. Avoid exposure. Some causes are electrical appliances or electrical equipment that produces a great deal of energy. Many of the home and office appliances are O.K to use, and undergoing certain medical and dental X-rays and diagnostic ultrasounds are also fine. Patients with a biventricular pacemaker should avoid magnetic resonance imaging, diathermy, excessive radiation, cautery, lithotripsy, and radiofrequency ablation.
How to find cardiologists for cardiac resynchronization therapy ?
Now you can find cardiologists for cardiac resynchronization therapy (CRT) from different hospitals and destinations on a single platform, Hinfoways. You can avail opinions and information from multiple cardiologists, get approximate cost of cardiac resynchronization therapy from various heart hospitals, compare things and then choose a cardiologist for cardiac resynchronization therapy.
Find and choose a cardiologist for cardiac resynchronization therapy on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
