Key Takeaways of Cardiac Resynchronization Therapy (CRT)

• Type of Procedure: Minimally invasive procedure with lead placement via a vein.
• Duration: Typically takes 2 to 4 hours.
• Anesthesia Used: Local anesthesia with conscious sedation; general anesthesia in some cases.
• Recovery Time: Most patients resume normal activities within 1 to 2 weeks, avoiding heavy lifting for a few weeks.

Types of Cardiac Resynchronization Therapy (CRT)

CRT-P (Cardiac Resynchronization Therapy with a Pacemaker)

• This type uses a pacemaker to coordinate activity of the heart's chambers, so the contractions of the heart are more synchronized.
• It's designed for patients with heart failure and abnormal heart rhythms (such as left bundle branch block) but without a high risk of life-threatening arrhythmias.

CRT-D (Cardiac Resynchronization Therapy with a Defibrillator)

• This device combines the functions of CRT with an implantable cardioverter-defibrillator (ICD).
• It provides resynchronization of the heart's contractions and also monitors for life-threatening arrhythmias, delivering shocks if needed to restore a normal rhythm.
• CRT-D is recommended for patients with heart failure who are at high risk for sudden cardiac arrest or life-threatening arrhythmias.

Indications of Cardiac Resynchronization Therapy (CRT)

Cardiac Resynchronization Therapy is primarily recommended for patients with moderate to severe heart failure and evidence of electrical conduction delays. The main indications include:

• Symptomatic Heart Failure CRT is recommended for patients with NYHA Class II, III, or ambulatory Class IV symptoms. These patients should remain symptomatic despite optimal medical therapy.
• Reduced Left Ventricular Ejection Fraction (LVEF) Indicated when LVEF is 35% or less. A low ejection fraction suggests weakened heart pumping efficiency.
• Prolonged QRS Duration QRS ≥ 120 ms, especially with LBBB pattern, indicates delayed ventricular activation. CRT helps resynchronize heart contractions in these cases.
• Sinus Rhythm Most effective in patients with normal sinus rhythm. Atrial fibrillation cases may need AV nodal ablation for CRT to work well.
• Dilated Cardiomyopathy Both ischemic and non-ischemic types with dyssynchrony respond to CRT. It helps improve ventricular coordination and function.
• Frequent Right Ventricular Pacing Patients with chronic RV pacing and reduced LVEF may develop pacing-induced dyssynchrony. CRT can reduce related heart failure symptoms.

CRT may not be suitable for all heart failure patients, especially those with narrow QRS complexes or those with reversible causes of heart failure. Proper evaluation using echocardiography and ECG is essential before recommending CRT.

Preparing for Cardiac Resynchronization Therapy

Preparing for Cardiac Resynchronization Therapy (CRT) involves several steps to ensure that you're ready for the procedure and that your health is optimized for a successful outcome. Here's a guide on how to prepare:

• Consultation: Meet with your cardiologist to determine if CRT is right for you and to review your medical history and tests.
• Medication Review: Discuss your current medications and follow instructions for any adjustments before the procedure.
• Fasting: Follow instructions on fasting before the procedure.
• Allergies and Medications: Inform your healthcare team of any allergies and provide a list of your medications.
• Hygiene: Clean the area of insertion well with light soap before the procedure.
• Transportation: You have to arrange for a driver to take you home from the procedure.
• Clothing: Wear comfortable clothes and avoid wearing jewellery.
• Follow Instructions: Follow your provider's instructions, including any changes to your medications.
• Inform Your Healthcare Team: Notify them if you have a pacemaker or defibrillator.
• Medical History: Provide relevant medical history, including previous heart conditions or surgeries.
• Ask Questions: If you have any questions or concerns, ask your provider.
• Healthy Lifestyle: Maintain a heart-healthy diet and exercise as advised to support recovery.

Steps Involved in Cardiac Resynchronization Therapy

Cardiac Resynchronization Therapy (CRT) is a specialized treatment for heart failure and certain heart rhythm disorders. It involves the implantation of a device, often called a CRT pacemaker or CRT defibrillator, to improve the synchronization of the heart's chambers and enhance its pumping efficiency.

Here are the general steps involved in a Cardiac Resynchronization Therapy procedure:

• Preoperative Evaluation: Your medical history, medications, and heart function are reviewed through tests like ECG and echocardiography.
• Consent and Anesthesia: You'll discuss the procedure with your healthcare provider, and informed consent is obtained. Anesthesia is given to ensure comfort.
• Implant Site Preparation: The area near the collarbone is cleaned and sterilized.
• Incision and Pocket Creation: A small incision is made, and a pocket is created under the skin for the CRT device.
• Lead Placement: Thin wires (leads) are inserted into the heart's chambers.
• Device Connection: Leads are connected to the CRT device, which is placed under the skin to monitor and synchronize heart contractions.
• Testing and Optimization: The device is tested to ensure the heart is synchronised correctly.
• Closure and Dressing: The incision is closed, and a sterile dressing is applied.
• Recovery and Observation: You'll wake up in a recovery area where vital signs are monitored.
• Hospital Stay: Most patients go home the same day, but an overnight stay may be needed.
• Postoperative Care and Follow-Up: You'll receive recovery instructions, and follow-up appointments are scheduled to check the device and heart function.

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Benefits of Cardiac Resynchronization Therapy

• Improved Heart Function: CRT enhances the coordination of the heart contractions, leading to better overall heart function and efficiency.
• Symptom Relief: The majority of patients achieve significant relief from symptoms like fatigue, shortness of breath and swelling.
• Increased Exercise Capacity: CRT can improve physical stamina and the capacity to engage in daily activities.
• Reduced Hospitalizations: CRT can help decrease the frequency of hospital visits due to heart failure complications.
• Improved Quality of Life: CRT has been shown to improve heart function and reduce symptoms, which can lead to a better quality of life.
• Lower Mortality Risk: For some patients, CRT can reduce the risk of death related to heart failure and arrhythmias.
• Improved Heart Rhythm: CRT can help regulate irregular heart rhythms and prevent arrhythmias, reducing the risk of complications like strokes.

Recovery after Cardiac Resynchronization Therapy

Recovery after a Cardiac Resynchronization Therapy (CRT) procedure is typically well-managed, and many patients experience improvements in their heart function and quality of life. Here's what you can expect during the recovery period:

• Post-Procedure Monitoring: You'll be monitored for a few hours to check stability and potential complications.
• Rest and Positioning: You may need to lie flat for a while to prevent bleeding at the insertion site.
• Wound Care: Follow instructions for cleaning and dressing the incision site.
• Pain Management: Mild pain is normal; take prescribed pain medication if needed.
• Medication: Take medications as prescribed by your doctor.
• Activity Restrictions: Avoid heavy lifting, strenuous activities, and intense exercise for a few weeks.
• Follow-Up Appointments: Regular visits to check on recovery and device function.
• Driving Restrictions: Avoid driving as directed, especially after sedation.
• Gradual Activity Resumption: Begin with light activities and progress as directed by your physician.
• Healthy Lifestyle: Maintain a heart-healthy diet, regular exercise, and stress management.
• Device Awareness: Be cautious of strong electromagnetic fields and inform professionals about your CRT device.
• Watch for Complications: Contact your doctor if you experience signs of infection, bleeding, or unusual symptoms.
• Seek Emotional Support: Reach out to your healthcare team, family, or friends for emotional support.

Lifestyle Changes After Cardiac Resynchronization Therapy

After undergoing Cardiac Resynchronization Therapy (CRT), adopting certain lifestyle changes can greatly contribute to your overall heart health, enhance the benefits of the procedure, and improve your quality of life. Here are some important lifestyle changes to consider:

• Follow a Healthy Diet: Eat fruits, vegetables, whole grains, lean proteins, and healthy fats. Reduce sodium, saturated fats and added sugars.
• Stay Active: Get 150 minutes of moderate exercise weekly, as advised by your doctor.
• Take Medications: Follow your doctor's instructions for prescribed medications.
• Quit Smoking: Stop smoking to improve heart health.
• Limit Alcohol: Drink alcohol in moderation.
• Manage Stress: Use a relaxation technique, such as yoga or breathing exercises.
• Attend Regular Check-Ups: Keep all follow-up appointments to monitor heart health.
• Monitor Fluid Intake: If needed, track your fluid intake to manage symptoms.
• Maintain Healthy Weight: Keep your weight in check to reduce strain on your heart.
• Control BP & Cholesterol: Manage blood pressure and cholesterol through lifestyle changes and medications.
• Manage Diabetes: Control blood sugar with diet, exercise, and medication.
• Prioritize Sleep: Aim for sufficient sleep each night.
• Stay Hydrated: Drink enough water for your heart to function properly.
• Limit Caffeine: Reduce caffeine if it causes heart palpitations or irregular rhythms.
• Support Emotional Well-Being: Seek support if needed and maintain a positive outlook.
• Communicate with Your Doctor: Report any changes in your health or symptoms promptly.