Yes, CRT can help improve your ejection fraction (EF).
EF is the measurement of how much blood is being pumped out of the left ventricle of the heart. A normal EF ranges from 50% to 70%. People with heart failure who have a poor ejection fraction are at risk for fast, irregular and sometimes life-threatening heart rhythms. The CRT/ICD combination device can help protect you against these dangerous, fast heart rhythms.
People with heart failure who have a poor ejection fraction (less than 35%) are at risk for fast, irregular and sometimes life-threatening heart rhythms. CRT may be appropriate for people who:
- Have severe or moderately severe heart failure symptoms
- Are taking medications to treat heart failure
- Have delayed electrical activation of the heart
- Have a history of cardiac arrest or are at risk for cardiac arrest
Before the procedure begins, a nurse will help you get ready. You will lie on a bed and the nurse will start an IV in a vein in your arm or hand. The IV is used to deliver medications and fluids during the procedure.
To prevent infection and to keep the pacemaker insertion site sterile:
- An antibiotic will be given through the IV at the beginning of the procedure
- For men, the left or right side of your chest will be shaved
- A special soap will be used to cleanse the area
- Sterile drapes are used to cover you from your neck to your feet
- A soft strap will be placed across your waist and arms to prevent your hands from touching the sterile area
Yes, a medication will be given through your IV to relax you and make you feel drowsy, but you will not be asleep during the procedure.
The CRT device can be implanted using the endocardial or epicardial approach.
With the endocardial approach (transvenous), a local anesthetic is injected to numb the area, and you will be awake during the procedure. Small incisions are made in the chest where the leads and device are inserted. The leads are inserted through the incision and into a vein, then guided to the heart with the aid of the fluoroscopy machine. Two leads are guided to the right atrium and right ventricle, while the third lead is guided through the coronary sinus to the left ventricle. The lead tips are attached to the heart muscle, while the other ends of the leads are attached to the pulse generator. The generator is placed in a pocket created under the skin in the upper chest. When the endocardial approach is used, the hospital recovery time is generally 24 hours. The endocardial technique is technically challenging. In some cases, this technique may not be successful due to the size, shape, or location of the vein(s). If the endocardial approach cannot be used or is unsuccessful, the epicardial approach will be used.
The epicardial approach may also be used to place the CRT if you are already having surgery to treat another heart condition. With the epicardial (surgical) approach, general anesthesia is given to put you to sleep during the procedure. The leads are guided to the heart with the aid of the fluoroscopy machine. Two leads are guided to the right atrium and right ventricle, while the third lead is guided through the coronary sinus to the left ventricle. The lead tips are attached to the heart muscle, while the other ends of the leads are attached to the pulse generator. The generator is placed in a pocket created under the skin in the lower abdomen. The hospital recovery time is generally 3 to 5 days. Although recovery with the epicardial approach is longer than that of the transvenous approach, minimally invasive techniques enable a shorter hospital stay and quicker recovery time. Your doctor will determine the best implant procedure approach for you, depending on your condition.
After the leads are in place, they are tested to make sure lead placement is correct, the leads are functioning properly and the right and left ventricles are synchronized.
This lead function test is called pacing. Small amounts of energy are delivered through the leads into the heart muscle. This energy causes the heart to contract. You will be asleep for several minutes during the lead function test.
Once the leads have been tested, the doctor will connect them to the device. The rate and settings of your CRT device are determined by your doctor. After the implant procedure, the doctor uses an external device to program final device settings.
With the endocardial approach, you will feel an initial burning or pinching sensation when the doctor injects the local numbing medication. Soon the area will become numb. You may feel a pulling sensation as the doctor makes a pocket in the tissue under your skin for the device. Please tell your doctor what symptoms you are feeling. You should not feel pain. If you do, tell your nurse right away.
With the epicardial (surgical) approach, you will be given anesthesia to put you asleep during the procedure, so you will not feel anything.
With both approaches, you may feel discomfort at the implant site during the first 48 hours after the procedure. The doctor will tell you what what medications you can take for pain relief. Please tell your doctor or nurse if your symptoms are prolonged or severe.
The device implant procedure may last from 2 to 5 hours.
Yes, you will be admitted to the hospital overnight. Usually you will be able to go home the day after your device was implanted, unless the epicardial approach was used during the procedure.