Understanding Cardiac Resynchronisation Therapy (CRT)
- Dr. Srinivasa Prasad B V
- Aug 25
- 4 min read
Heart failure is a complex condition that affects millions worldwide. It occurs when the heart cannot pump blood efficiently to meet the body's needs. One of the advanced treatments available for certain types of heart failure is cardiac resynchronisation therapy. This therapy aims to improve the heart's function by coordinating its contractions. Understanding this treatment can help patients and caregivers make informed decisions about managing heart failure.
The Role of Cardiac Resynchronisation Therapy in Heart Failure
Cardiac resynchronisation therapy is designed for patients whose heart ventricles do not beat in sync. Normally, the heart's electrical system ensures that the left and right ventricles contract simultaneously, pumping blood effectively. However, in some heart failure cases, this coordination is lost, leading to inefficient blood flow and worsening symptoms.
This therapy uses a specialized device, similar to a pacemaker, to send electrical impulses to both ventricles. By doing so, it restores synchronized contractions, improving the heart's pumping ability. Patients often experience reduced symptoms such as fatigue and shortness of breath, and their overall quality of life can improve significantly.
How Cardiac Resynchronisation Therapy Works
The therapy involves implanting a small device under the skin near the collarbone. This device connects to leads that are threaded through veins into the heart. Typically, three leads are placed: one in the right atrium, one in the right ventricle, and one in a vein on the surface of the left ventricle.
The device monitors the heart's rhythm and sends timed electrical signals to both ventricles. This timing helps the heart chambers contract together, improving the efficiency of each heartbeat. The procedure usually takes a few hours and is performed under local anesthesia with sedation.
Patients are monitored closely after implantation to ensure the device is functioning correctly. Adjustments to the device settings may be made during follow-up visits to optimize therapy benefits.
What is the basic concept of CRT?
At its core, the concept behind cardiac resynchronisation therapy is to correct the electrical delay that causes the heart's ventricles to beat out of sync. This delay, often seen in patients with left bundle branch block or other conduction abnormalities, leads to inefficient heartbeats.
By delivering electrical impulses to both ventricles simultaneously, the therapy resynchronizes their contractions. This synchronization enhances the heart's ability to pump blood, reduces the workload on the heart muscle, and can slow the progression of heart failure.
The therapy is particularly beneficial for patients with moderate to severe heart failure symptoms who have a reduced ejection fraction and evidence of ventricular dyssynchrony on an electrocardiogram (ECG).
Who Can Benefit from Cardiac Resynchronisation Therapy?
Not all heart failure patients are candidates for this therapy. Ideal candidates typically have:
Moderate to severe heart failure symptoms despite optimal medical treatment
A reduced left ventricular ejection fraction (usually 35% or less)
Evidence of ventricular dyssynchrony, such as a widened QRS complex on ECG
Stable heart rhythm, often sinus rhythm, although some patients with atrial fibrillation may also benefit
Before recommending therapy, doctors perform thorough evaluations including echocardiograms, ECGs, and sometimes stress tests. These assessments help determine if the patient’s heart condition aligns with the therapy’s indications.
Patients with certain conditions, such as recent heart attacks or infections, may need to wait before receiving the device. Additionally, the risks and benefits are carefully weighed, especially in older adults or those with other serious health issues.
What to Expect After Cardiac Resynchronisation Therapy
After the device implantation, patients usually stay in the hospital for a day or two for monitoring. The medical team checks the device function and ensures there are no complications such as infection or lead displacement.
Patients are advised to avoid strenuous activities for several weeks to allow the leads to settle in place. Regular follow-up visits are essential to monitor heart function and device performance. During these visits, the device settings may be adjusted to maximize therapy effectiveness.
Many patients notice improvements in symptoms within weeks to months. These improvements include increased energy levels, better exercise tolerance, and fewer hospitalizations for heart failure.
It is important to continue taking prescribed medications and maintain a heart-healthy lifestyle. The device complements medical therapy but does not replace it.
Potential Risks and Considerations
Like any medical procedure, cardiac resynchronisation therapy carries some risks. These include:
Infection at the implantation site
Bleeding or bruising
Lead displacement or malfunction
Rarely, damage to blood vessels or the heart during lead placement
Patients should report any signs of infection, swelling, or unusual symptoms promptly. Regular device checks help detect and address any technical issues early.
The therapy is not a cure for heart failure but a tool to manage symptoms and improve heart function. Patients should maintain realistic expectations and work closely with their healthcare team.
The Future of Cardiac Resynchronisation Therapy
Advances in technology continue to improve the effectiveness and safety of cardiac resynchronisation therapy. Newer devices offer features such as remote monitoring, allowing doctors to track device function and heart rhythms from a distance.
Research is ongoing to identify which patients benefit most and to refine patient selection criteria. Personalized programming of devices is becoming more common, tailoring therapy to individual heart patterns.
As understanding of heart failure grows, cardiac resynchronisation therapy remains a vital option for many patients seeking better symptom control and improved quality of life.
For those interested in learning more about this treatment, consulting with a cardiologist experienced in device therapy is recommended. They can provide detailed information tailored to individual health needs.
For more detailed information, visit CRT.
Understanding cardiac resynchronisation therapy helps patients and caregivers navigate treatment options with confidence. This therapy offers hope for improved heart function and daily living for many facing the challenges of heart failure. With ongoing medical support and lifestyle management, patients can take meaningful steps toward better heart health.
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