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resynchronization therapy (CRT) uses a special type of pacemaker called a biventricular pacemaker (say "by-ven-TRICK-yuh-ler") to treat heart failure. This pacemaker sends electrical pulses to make the
ventricles pump at the same time.
A biventricular pacemaker is
implanted in the chest, and it connects to three thin wires, called leads. The
leads go into different chambers of your heart. If there is a problem with your
heartbeat, the pacemaker sends a painless signal through the leads to fix the
problem. The pacemaker also can speed up your heart if it is beating too
In some cases, you may get a pacemaker that is combined with a device to shock your heartbeat back to a normal rhythm
if it is dangerously fast. The device is called an implantable
cardioverter-defibrillator, or ICD. It can prevent sudden death.
Your doctor will put
the pacemaker in your chest during minor surgery. You will not have open-chest
Your doctor makes a small cut (incision) in your chest. The doctor puts the leads in a vein and threads them to the heart. Then your doctor connects the leads to the pacemaker. Your doctor
programs the pacemaker and then puts it in your chest and closes the
Most people spend the night in the
hospital, just to make sure that the device is working and that there are no
problems from the surgery. But sometimes the procedure is done as an
outpatient procedure, which means you don't need to
stay overnight in the hospital.
You may be able to see a little
bump under the skin where the pacemaker is placed.
When you have
heart failure, the
lower chambers of your heart (the ventricles) aren't able to pump as much
blood as your body needs. Sometimes the heart has a problem with the electrical
system that controls the pumping. This means the ventricles don't pump at the
right time or the heart has an abnormal rhythm. A pacemaker for heart failure
can help the heart pump blood better.
Whether a pacemaker for heart failure is right for you depends on many medical facts. Your doctor will check many things including:1, 2
A pacemaker can help your heart pump blood better. It may help you feel better so you can be more
active. It also may help keep you out of the hospital and help you live
A pacemaker can slow the progression of heart failure. It can do this by helping the heart's electrical system work well and by changing the shape of your heart. In heart failure, the left ventricle often
gets too big as it tries to make up for not pumping well. The pacemaker can slow down this change in your ventricle. It might even
help your ventricle go back to a more normal size.
There are several risks to getting a pacemaker. But risks
vary for each person. The chance of most problems is low.
The procedure to implant a pacemaker is safe, and most people do well afterward. Afterward, you will see your doctor regularly to check your pacemaker and make sure you don't have any problems.
If problems happen during the procedure, doctors likely can fix them right away.
Problems after the procedure can be minor, like mild pain, or serious, like an infection. But your doctor can solve most of these problems. And most people do not have long-term issues with their pacemakers.
activities and situations can interrupt the signals sent by the pacemaker to
the heart. You may need to adapt some of your activities. Follow your doctor's
specific instructions about care and precautions if you have a
If you get a pacemaker, you have to be careful
not to get too close to some devices with strong magnetic or electrical fields.
MRI machines, battery-powered cordless power tools,
and CB or ham radios. But most everyday appliances are safe.
Complete the special treatment information form (PDF)special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
Epstein AE, et al. (2013). 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. Circulation, 127(3): e283–e352.
Yancy CW, et al. (2013). 2013 ACCF/AHA Guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16): e147–e239.
McAlister FA, et al. (2007). Cardiac resynchronization
therapy for patients with left ventricular systolic dysfunction: A systematic
review. JAMA, 297(22): 2502–2514.
Tang ASL, et al. (2010). Cardiac-resynchronization therapy for mild-to-moderate heart failure. New England Journal of Medicine, 363(25): 2385–2395.
Van Rees JB, et al. (2011). Implantation-related complications of implantable cardioverter-defibrillators and cardiac resynchronization therapy devices. Journal of the American College of Cardiology, 58(10): 995–1000.
Akoum NW, et al. (2008). Pacemaker therapy. In EG Nabel, ed., ACP Medicine, section 1, chap. 7. Hamilton, ON: BC Decker.
Baddour LM, et al. (2010). Update on cardiovascular implantable electronic device infections and their management. A scientific statement from the American Heart Association. Circulation, 121(3): 458–477.
McKelvie R (2011). Heart failure, search date August 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Other Works Consulted
Bogale N, et al. (2012). The European CRT survey: 1 year (9–15 months) follow-up results. European Journal of Heart Failure, 14(1): 61–73.
Lampert R, et al. (2010). HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm, 7(7): 1008–1026. Available online: http://www.hrsonline.org/Policy/ClinicalGuidelines/upload/ceids_mgmt_eol.pdf.
November 8, 2013
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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