Cardiac Resynchronization Therapy (CRT)

Types of CRT Devices

• CRT-P (Cardiac Resynchronization Therapy – Pacemaker): helps synchronize the heart's electrical activity to improve heart function.
• CRT-D (Cardiac Resynchronization Therapy – Defibrillator): in addition to pacing therapy, includes a built-in defibrillator that can deliver shocks to correct life-threatening rhythms such as ventricular tachycardia or fibrillation.

What to Expect During the Procedure

• The procedure is performed under local anesthesia with sedation, meaning you will be awake but comfortable.
• A small incision will be made near the collarbone to create a pocket for the CRT device.
• Two or three leads (thin wires) will be inserted through veins and guided to the heart: one in the right atrium, one in the right ventricle, and one in a vein over the left ventricle to improve synchronization.
• The CRT device will be tested to ensure proper function before the incision is closed.
• The procedure typically takes 1 to 3 hours.
• If a CRT procedure is not possible, your doctor may choose to perform a different type of pacemaker such as Conduction System Pacing.

Risks Involved

While CRT implantation is a routine and safe procedure, potential risks include:

• Bleeding or bruising at the insertion site.
• Infection at the device site, which may require antibiotics or, in rare cases, removal of the device.
• Lead displacement, which may require repositioning in a follow-up procedure.
• Pneumothorax (collapsed lung), a rare complication due to accidental lung puncture during lead placement.
• Cardiac perforation. In extremely rare cases, open-heart surgery may be needed.
• Inappropriate shocks (CRT-D only), where the device delivers a shock when it is not needed, requiring device reprogramming.
• Allergic reaction to anesthesia or contrast dye (if used during the procedure).

What to Expect After the Procedure

• Mild pain, swelling, or bruising at the incision site, which should improve over several days.
• Restricted arm movement on the side of the device for 4-6 weeks to allow proper healing.
• Follow-up appointment will be scheduled within a few weeks to check device function and incision healing.
• The CRT device battery typically lasts 5-15 years, depending on usage and type (CRT-P vs. CRT-D).

Activity and Lifestyle Adjustments

• Avoid lifting heavy objects or raising the arm above shoulder level on the affected side for at least 4-6 weeks.
• Most routine activities, including walking and light exercise, can be resumed the next day.
• Inform airport security about your CRT device, as it may set off metal detectors.
• Avoid strong magnets and electrical fields. If your occupation involves exposure to high electrical fields (e.g., arc welding), consult your doctor.
• Driving restrictions may apply if you have received a CRT-D for high-risk arrhythmias — your doctor will provide specific guidance.

When to Seek Medical Attention

Go to the Emergency Room if you experience:

• Severe pain, redness, swelling, or discharge at the CRT site. (If mild, contact our ICD clinic for an urgent appointment.)
• Persistent dizziness, shortness of breath, or extreme fatigue.
• Sudden swelling of the arm on the side of the CRT device.
• Palpitations or an irregular heartbeat.
• If you receive a shock from a CRT-D and feel unwell, or if you receive multiple shocks.

Follow-Up Care

• You will have a follow-up visit within 2-6 weeks to check CRT function.
• Routine CRT checks are needed every 6-12 months to monitor battery life and device performance.
• If you experience worsening heart failure symptoms or unexpected shocks (CRT-D), contact our office for evaluation.