Procedures

Cardiac Device

Cardiac Resynchronisation Therapy (CRT)

Cardiac resynchronisation therapy (CRT) is a procedure where a device is implanted in your chest to make your heart’s chambers contract in a more organised and efficient way. CRT is performed using a special form of pacemaker known as a bi-ventricular pacemaker and is most commonly used in patients with heart failure where electrical signals do not flow through the heart normally.

This device is implanted with a minor surgical incision under the skin beneath the collarbone. Electrical cables run from the device to the heart to stimulate it to beat more strongly and in a more coordinated manner. Patients in whom a CRT device is indicated are often also prone to abnormally fast heart rhythms that can be dangerous and gives rise to sudden death. Therefore, most patients will receive a CRT device that incorporates defibrillator functions (known as CRT-D). Sometimes your doctor may consider this feature not appropriate for you and will discuss this with you. In this case, you will receive only a CRT pacemaker (known as CRT-P).

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An image of a Medtronic heart rhythm device

What is involved in CRT implant?

CRT insertion is a common procedure. This is performed under general anaesthetic but can be performed under local anaesthetic with sedation if required. The procedure takes approximately 1 to 2 hours and is performed in the cardiac catheter laboratory. This is a special room that has a patient table, X-Ray, ECG monitors and other equipment. The staff in the lab will all be dressed in hospital theatre clothes during the procedure and will be wearing hats and masks. Many ECG monitoring electrodes will be attached to your chest area. A nurse or doctor will insert an intravenous line usually into the back of your hand. This is a reliable way to give you medications during the study without further injections.

You will also have a blood pressure cuff attached to your arm that will automatically inflate at various times throughout the procedure. There will also be considerable attention at cleaning the skin under the collarbone where the device will be inserted. You will also receive antibiotics prior to the procedure. You should ensure that you inform the doctor is you have any allergies. The CRT device is inserted just under the collarbone. The area is prepared with a special sterile solution that may feel cold. A large sterile sheet that will partly cover your face and will cover you. You will be able to look out from under the sheet to the side and a nurse will be present at all times. You will be given oxygen to breathe by a small tube that is positioned under your nostrils. If you are receiving a CRT-D device, at the end of the procedure a fast heart rhythm will be induced and the effectiveness of the ICD will be tested. For this testing, you will receive stronger sedation if not under a general anaesthetic.

After the procedure

After the procedure, you will have some bruising and discomfort in the area of the pacemaker that may persist for 1-2 weeks. You should avoid strenuous activities with your arm for a period of 4 weeks – this is very important after your procedure to avoid the leads from moving. If the leads do move you will need to re-admit to the hospital for a lead revision. If the CRT device is implanted without previous rhythm disturbance, (primary prevention) you are legally required to refrain from driving for 2 weeks after the procedure. If the CRT device is implanted after a previous rhythm disturbance (primary intervention) you are legally required to refrain from driving for 6 months and then after clearance by your doctor. You will be allowed to go home 1 or 2 days after the procedure and a follow-up appointment will be arranged to have your device checked in the clinic.