Cardiac Resynchronisation Therapy (CRT)

Cardiac resynchronisation therapy is a treatment to help the heart pump blood more efficiently by resynchronizing the contractions of the heart’s chambers. This is done by implanting a cardiac resynchronisation device in the chest with leads attaching to the heart chambers.

This treatment is useful for patients with heart failure. Patients with heart failure often have weakened heart muscles, which ventricles do not contract at the same time, resulting in reduced efficiency of the pump.

Electrical signals are emitted through the cardiac resynchronisation device, causing the heart to beat in a more organized and efficient manner. This treatment aims to improve the heart’s pump function; hence reducing symptoms of heart failure and risk of heart failure complications.

Risks Factors

Complications associated with cardiac resynchronization therapy are very low. The potential risks include bleeding from insertion of leads into the veins during the surgery and infection of the device and lead systems. However, antibiotics are routinely given to reduce the risk of infection and further complications.

Cardiac resynchronisation therapy requires a minor surgical procedure to implant the device in your chest and its leads delivered to the heart muscles. The patient will receive general sedation and local anesthetic to the chest wall region where the device is to be implanted. The procedure typically takes a few hours and is similar to a pacemaker implantation. During surgery, a small incision is made in the skin under the collarbone and insulated wires are placed into a major vein. One end of the wire is secured to the heart, while the other end is attached to the device.

Risks of the procedure is generally low at 1-2%, which includes complications of heart attack, bleeding, infection, stroke, injuries to surrounding structures in the chest needing emergency intervention, and death.

The patient will usually stay overnight in the hospital after the surgery. Chest X-ray will be done to check the position of the device and leads and to look for complications. Device check will be done on the following day before the patient is discharged.

The patient may be advised to stop certain medications before the treatment. The patient should also inform the doctor of any allergy, such as allergies to X-ray contrast, heart rhythm medications or pain-relieving medication.

Post implantation, wound care will be taught to the patient and appointments will be given to ensure proper wound healing.

Regular assessment of the device’s battery life and functionality is compulsory for all patients with a CRT device. Hence, patients are required to return to National Heart Centre Singapore for regular follow-up sessions.  When the device’s battery is depleted after a few years, it will need to be replaced by another minor surgical procedure.