CRT-D

Heart failure can be due to a reduced pumping function of the heart.  Although tablets can make you feel better and live longer some people still have symptoms and their life span is reduced despite being on all the right medication.   In a proportion of people the pumping action of the heart is not coordinate and this is picked up on the ECG.  Inserting a pacemaker with leads to stimulate both the sides of the heart can re-time the heart and is known as cardiac resynchronisation therapy CRT or biventricular pacing.  This type of treatment has been shown to make people feel better, live longer and in some people even improve the heart function. 

How is CRT done?

Cardiac resynchronisation pacemakers are implanted just like a normal pacemaker under local anaesthetic and sedation.  The leads are placed inside the right side of the heart through veins underneath your collar bone usually on the left hand side and guided into position using x-ray.  In order to pace the left side of the heart the vein that drains the left side of the heart (coronary sinus) is accessed from the top right sided chamber and a lead is placed in one or the branches which overlies the outer surface of the left ventricle.  (link to slide 1)

The anatomy of the coronary sinus is variable and so this part can take longer than a normal pacemaker and typically these procedures can take up to 90-120mins. 

Cardiac resynchronisation therapy can be combined with a defibrillator or a pacemaker.  The choice is dependent on a number of factors and at Wiltshire cardiology we will take the time to explain our recommendation to help you choose the right treatment for you.