Cardiac Resynchronization Therapy

What you should know

Cardiac resynchronization therapy (CRT) is a procedure used to treat problems with how your heart beats. CRT is also called biventricular pacing. Your heart has 2 upper chambers, called atria, and 2 lower chambers, called ventricles. Your heartbeat is synchronized when all areas of your heart beat together properly. When the areas of your heart do not beat as they should, your heart cannot pump enough blood and oxygen to your body. You may have trouble breathing, tire easily, and have swelling in your legs and feet.


Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

  • You may need a large chest incision if the leads cannot be placed through your vein or small cuts. You may get a wound infection, or an infection around the pacemaker implant. The activity of the pacemaker may make it hard for you to breathe at times. Your heart, blood vessels, and the area around them may be damaged. You may have abnormal heartbeats, and your heart may stop beating. Blood may collect around your heart, making it hard for your heart to beat. This can be life-threatening.

  • The leads in your heart may move out of place. The leads may not be in the right position to synchronize your heartbeats. The pacemaker may not work properly. If you do not have CRT, your symptoms may worsen. You may have abnormal heartbeats that stop your heart. Your heart failure may get worse, and may become life-threatening.

Getting Ready

Before your procedure:

  • Write down the correct date, time, and location of your procedure.

  • Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.

  • Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.

  • You may need blood tests before your procedure. You may need an EKG, echocardiogram, or MRI to check your heart function. A vein x-ray may also be done to help your caregiver plan your procedure. Talk to your caregiver about these or other tests you may need. Write down the date, time, and location for each test.

The night before your procedure:

Ask caregivers about directions for eating and drinking.

The day of your procedure:

  • Ask your caregiver before taking any medicine on the day of your procedure. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring a list of all the medicines you take, or your pill bottles, with you to the hospital.

  • You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

  • Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.

  • An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.

Treatment

What will happen:

  • A small incision is made over a vein near your neck. An x-ray may be used to help guide your caregiver during the procedure. An electrode catheter holding 3 leads will be inserted through the incision. The catheter and leads are guided into your heart. The catheter records the activity of your heart to help your caregiver decide where to place the leads. One lead is placed in your right atrium, one in your right ventricle, and one in your left ventricle.

  • If any of the leads cannot be placed through your vein, they may be placed through your chest. Three or four small cuts are made on your left side, between your ribs. The leads are placed directly on your heart. Once the leads are placed, a pacemaker is secured under the skin on your chest. The pacemaker will help your ventricles beat together and beat correctly with your right atrium. Caregivers will close your incisions with stitches or medical glue.

After your procedure:

You will be taken to a room to rest until you are fully awake. Caregivers will monitor you closely for any problems. Do not get out of bed until your caregiver says it is okay. You may need an EKG, echo, or chest x-ray to check the placement of the leads in your heart. When your caregiver sees that you are okay, you will be taken to your hospital room.

Contact a caregiver if

  • You cannot make it to your procedure.

  • You have a fever.

  • You get a cold or the flu.

  • You have questions or concerns about your procedure.

Seek Care Immediately if

  • Your heart problems get worse.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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