Cardiac Resynchronization Therapy

What you should know

• Cardiac resynchronization therapy (CRT) treats problems with how your heart beats. CRT is also called biventricular pacing. Your heart has two upper chambers (rooms) called atria, and two lower chambers called ventricles. Your heartbeat is synchronized when all areas of your heart beat together properly. During each heartbeat, electrical activity causes your atria to contract (squeeze) first, followed by the ventricles. When the chambers of your heart do not beat as they should, it is called dyssynchrony. When dyssynchrony occurs, your ventricles may not pump enough blood and oxygen to your body. Blood may flow back from your ventricles to your atria. You may have trouble breathing, tire easily, and have swelling in your legs and feet.
  
  
• Heart failure and electrical activity blockages in your heart may lead to dyssynchrony. Dyssynchrony often occurs in the left ventricle, causing it to contract later than it should. For CRT, a pacing device (small battery-powered machine) is implanted under your skin, in your chest. The pacing device has leads (wires) that attach to certain areas in your heart. This device uses electrical energy to fix the timing of your heartbeat. CRT may help your heart pump properly, and improve blood and oxygen flow in your body. CRT may decrease the backflow of blood in your heart. Having CRT may decrease your symptoms, and allow you to breathe better and have more energy.

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 have an allergic response to the medicines and dye used during your procedure. You may need a large chest cut 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. Placing the pacemaker may cause your lung to collapse. 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, which 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. Even after starting CRT, your symptoms or condition may not get better. Electric devices, such as cell phones and security systems may interfere with your pacemaker.
  
  
• If you do not have CRT, your symptoms, such as weakness, dizziness, and trouble breathing may worsen. You may have abnormal heartbeats that stop your heart. Your heart failure may get worse, and you could die. Talk to your caregiver if you have questions or concerns about your treatment, condition, or care.

Getting Ready

Before your procedure:

• 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.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• You may need blood tests before your procedure. You may need an EKG, echocardiogram, or magnetic resonance imaging (MRI) to check your heart, and how it beats. You may need a venography (vein x-ray) to help your caregiver plan your procedure. Ask your caregiver about these and other tests you may need. Write down the date, time, and location of each test.

The night before your procedure:

• Ask caregivers about directions for eating and drinking.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your procedure. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before the procedure. You may need to check your blood sugar more often before and after having your procedure.

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• 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.
  
  
• Ask your caregiver before you take any medicine on the day of your surgery. Bring a list of all the medicines you take, or your pill bottles, with you to the hospital. Caregivers will check that your medicines will not interact poorly with the medicine you need for surgery.
  
  
• 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 may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• You will be taken to the room where your procedure will be done. You may get a shot of local anesthesia medicine to numb the procedure area. Your caregiver may give you general anesthesia medicine, which will keep you asleep during your procedure. A small incision (cut) is made over a vein near your neck. Fluoroscopy (a type of x-ray) may be used to help guide your caregiver during the procedure. An electrode catheter (tube) holding three leads will be inserted through the cut. 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. If you have abnormal heartbeats, your caregiver may do an ablation on the area creating the abnormal heartbeats. You may also have a defibrillator (ICD) placed in your heart to control life threatening abnormal heartbeats. Ask your caregiver for more information about ablation and ICD placement. Once the leads are placed, the pacemaker is secured under the skin on your chest. The pacemaker will help your ventricles beat together and in synchrony with your right atrium. Caregivers will close your cuts when your procedure is complete.

After your procedure:

You are taken to a room where you can rest. Do not get out of bed until your caregiver says it is okay. Caregivers will check your vital signs often. Vital signs include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). You may need an EKG or echocardiogram to check your heartbeat. You may have a chest x-ray to check the placement of the leads in your heart. Caregivers will check for bleeding from your wounds (procedure area). When caregivers see that you are not having problems, you may be taken back to your room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your procedure.
  
  
• You feel dizzy or light-headed.
  
  
• You feel more tired than normal.
  
  
• You feel short of breath during activity.
  
  
• You have a fever.

Seek Care Immediately if

• You feel like your heart is fluttering or jumping in your chest.
  
  
• You faint (pass out).
  
  
• You have new or increased swelling in your legs or feet.
  
  
• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing