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Royal Sussex County Hospital. Princes Royal Hospital. Hove Polyclinic. Sussex Universities

Cardiac Resynchronisation Therapy (CRT) - Pacemaker

What is Cardiac Resynchronisation Therapy (CRT)?
CRT devices are used to treat heart failure and can be a permanent pacemaker with or without an Implantable Cardioverter Defibrillator (ICD). They improve overall function of the heart and make the main pumping chambers of the heart beat at the same time.

CRT- Pacemaker
If you have an abnormality in the electrical pathway of your heart which upsets its regular beating,
a pacemaker can be inserted to produce electrical impulses to make your heart chambers pump more regularly. CRT-Pacemakers work like traditional pacemakers but are more advanced. In heart failure the left side of the heart may not pump at the same time as the right, meaning the two sides of the heart lose their coordination. CRT-pacemakers have an additional lead which helps restore the hearts coordination and make the heart beat more efficiently. It is important to note that any device is NOT a replacement for your heart failure medication.

How is a CRT- Pacemaker fitted?
This procedure is normally performed under a local anaesthetic. You will be sedated to make sure
you are relaxed and sleepy. A small box is placed under the skin in your chest, just below your collar bone. This is connected to small leads which pass through a vein into three sites in the heart.
The implant should take between 2 – 4 hours, sometimes longer and you will need to lie quite flat for this time. Any stitches that may need to be subsequently removed will be done at your GP surgery.

What happens after the CRT-Pacemaker is fitted?
You will probably be allowed to go home the next day, provided your CRT-Pacemaker is checked,
there are no complications and your doctor assesses it is safe. It is important that you tell the nurse immediately if you have any pain or discomfort. The wound should be kept dry until it has fully healed, although it is fine to have a bath or a shower. You will be given a CRT-Pacemaker identity card with details of the make and model of your CRTPacemaker. This card should be kept with you at all times. If you require further treatment in the future it is essential that you show the card to the
medical professional who is treating you.

Are there any risks associated with the procedure?
There are some small risks associated with having a CRT-Pacemaker fitted. Generally the most
common risks are:

♥ A small risk of infection, bleeding and bruising to the pacemaker site.
♥ A small risk of lead displacement – the pacemaker lead can move and would then need repositioning
♥ A small risk of perforation of the lung during the procedure

Occasionally after a CRT implant patients may experience chest twitching caused by irritating a
nerve near some of your breathing muscles. This can usually be corrected by resetting the CRTPacemaker.

Occasionally when implanting CRT-Pacemakers it is not possible to position the extra lead. If this
happens the doctor will discuss other options for placing the lead with you which would involve another procedure.

Will I feel anything different?
You should not be aware of the CRT-Pacemaker working but occasionally people are conscious of
their heart beating faster, particularly if you had a very slow heart rhythm before the pacemaker
was implanted. The CRT-Pacemaker will not usually stop the heart from speeding up so if you had fast palpitations before then they may continue. If this occurs the palpitations are usually treated by medication. The CRT-Pacemaker will be set to enable your own heart to work as much as possible on its own and will only come in if your heart rhythm slows down to a certain level. It works on ‘demand’.

What about driving?
There will be some restrictions but these will vary depending on why you have had your CRT-Pacemaker fitted. You can access DVLA guidelines on: MedicalRulesForDrivers/index.htm

You must inform the DVLA that you have had a CRT-Pacemaker implanted. You must also make
sure that you inform your insurance company.

You should always contact your ICD centre if you think you have had a shock. Any further questions please contact the Arrhythmia Nurse Specialist on 01273 696955 Ext 4071 or the cardiac department at RSCH on 01273 696955

Courtesy of Arrhtyhmia Alliance. Registered Charity No. 1107496 ©2010