Cardiac Resynchronisation Therapy (CRT) is an advanced treatment for heart failure that helps restore the heart’s rhythm and improve its ability to pump blood efficiently. In patients with heart failure, the lower chambers of the heart (ventricles) can lose their synchronization, which affects the heart’s overall function. CRT works by coordinating the contractions of the ventricles, helping the heart pump blood more effectively.

CRT is especially beneficial for patients who suffer from moderate to severe heart failure and have an abnormal heart rhythm, particularly those with left bundle branch block (LBBB). This therapy improves symptoms and can enhance the patient’s quality of life, reduce hospitalizations, and prolong survival.

How Does CRT Work?

CRT involves the use of a specialized device, similar to a pacemaker, implanted in the chest. The device sends small electrical impulses to both the left and right ventricles, ensuring they beat more synchronized. This resynchronization helps the heart pump more efficiently and can reduce the symptoms of heart failure.

Key Components of CRT:

• CRT Device: The device has a generator that is implanted under the skin, usually below the collarbone.

• Leads (Wires): Three wires are connected to the heart:

• One to the right atrium
• One to the right ventricle
• One to the left ventricle (through the coronary sinus)

These leads deliver electrical impulses to the heart, ensuring the ventricles contract simultaneously.

• Synchronization: The CRT device monitors the heart’s rhythm and delivers electrical impulses to synchronize the ventricles, which helps optimize the heart’s pumping action.

Who Needs Cardiac Resynchronisation Therapy?

CRT is recommended for patients who:

• Have mild to severe heart failure (NYHA Class III or IV).
• Suffer from left ventricular dysfunction with an ejection fraction of 35% or less.
• Have an abnormal electrical system in the heart, like a left bundle branch block (LBBB).
• Experience symptoms like shortness of breath, fatigue, and reduced ability to exercise despite optimal medication management.

CRT can significantly improve symptoms in such patients and, in some cases, may also prevent the progression of heart failure.

The CRT Implantation Procedure

The CRT device is implanted in a minimally invasive procedure, similar to a pacemaker implantation. Here’s an overview of how the procedure works:

• Preparation: The procedure is usually performed under local anesthesia with mild sedation. The patient is awake but comfortable.
• Device Implantation: The doctor makes a small incision near the collarbone and inserts the CRT device. The three leads are guided through a blood vessel and positioned inside the heart.
• Testing and Adjustments: Once the leads are positioned, the device is tested to ensure it works properly. Adjustments are made to ensure optimal synchronization of the ventricles.
• Post-Procedure: Most patients stay in the hospital for a day or two to monitor for any complications. Full recovery generally takes several weeks, during which regular follow-up visits are scheduled to check the device’s function.

Benefits of Cardiac Resynchronisation Therapy

• Improves Heart Function: By resynchronising the ventricles, CRT helps the heart pump blood more efficiently.
• Relieves Symptoms: CRT can alleviate symptoms such as shortness of breath, fatigue, and fluid retention, improving the patient’s overall well-being.
• Enhances Quality of Life: Many patients experience an improvement in their ability to perform day-to-day activities and engage in physical exercise.
• Reduces Hospitalisations: CRT helps reduce the need for hospitalization due to worsening heart failure.
• Prolongs Life: In some cases, CRT can help extend the lives of heart failure patients by slowing the progression of the disease.