Resynchronization Device

In a healthy heart, electrical signals travel rapidly through both the right and left ventricles, causing them to contract together and efficiently pump blood. For some patients with heart failure, however, this electrical “wiring” is damaged, often resulting in the left ventricle contracting later than the right. A CRT device is a sophisticated pacemaker that sends tiny electrical pulses to both ventricles, “resynchronizing” their contraction so the heart can pump more effectively. With CRT, many patients experience fewer symptoms such as fatigue and shortness of breath and are able to return to daily activities they previously found difficult, resulting in a noticeable improvement in their quality of life.

This educational video has been chosen by our cardiology team. Suggested or related videos displayed by the video provider are outside of our control and do not represent the views or endorsements of our physicians or clinic.

Doctors typically recommend CRT for patients who meet specific criteria, as it is designed for a particular type of heart dysfunction.

• Heart Failure Symptoms: Moderate to severe symptoms (like shortness of breath or fatigue) despite taking optimal medications.
• Reduced Ejection Fraction (EF): A measurement showing the heart is pumping significantly less blood than normal (usually an EF of 35% or lower).
• Ventricular Dyssynchrony: Evidence on an EKG (Electrocardiogram) that the electrical signal is delayed, often seen as a Left Bundle Branch Block (LBBB).
• QRS Duration: A wide “QRS complex” on an EKG (usually wider than 130 milliseconds), indicating the ventricles are taking too long to contract.

A standard pacemaker usually has one or two “leads” (wires) to pace right atrium and/or right ventricle. A CRT device is unique because it uses an extra lead to pace the left bottom chamber, left ventricle that has a delayed contraction:

1. Right Atrium: Monitors the heart’s natural rhythm.
2. Right Ventricle: Provides pacing to the right side.
3. Left Ventricle: This lead is placed via the coronary sinus (a vein on the outside of the heart) to pace the left side.

By timing the pulses to the left and right ventricles efficiently, the device ensures the heart wall moves inward together, maximizing the stroke volume (the amount of blood ejected with each beat).

Implantation Process

The procedure is “minimally invasive,” meaning it does not require open-heart surgery. It is typically performed in a Cardiac Catheterization Lab or Electrophysiology (EP) Lab.

Step 1: Preparation: The patient is usually given a sedative and local anesthesia. A small incision (about 2 inches) is made near the left shoulder groove area.

Step 2: Lead Placement: The doctor uses X-ray imaging to guide thin wires (leads) through a vein into the heart. For resynchronization, the left ventricular lead is inserted via the right atrium into the coronary sinus outside the heart.

Step 3: Testing: The leads are connected to the device, and the team tests the electrical signals to ensure optimal placement.

Step 4: Pocket Creation: The “pulse generator” (the battery-powered computer) is tucked into a small pocket created under the skin.

Step 5: Closing: The incision is closed with sutures or medical glue. The procedure typically takes 2 to 4 hours.

This educational video has been chosen by our cardiology team. Suggested or related videos displayed by the video provider are outside of our control and do not represent the views or endorsements of our physicians or clinic.

Note: Recovery usually involves a short hospital stay (often overnight). Patients are typically advised to avoid heavy lifting or reaching high over their heads with the affected arm for a few weeks to allow the leads to settle firmly in place.

This educational video has been chosen by our cardiology team. Suggested or related videos displayed by the video provider are outside of our control and do not represent the views or endorsements of our physicians or clinic.

PRE-PROCEDURE 

• The night before your procedure AND the morning of your procedure please cleanse with an antimicrobial soap, like Dial or Hibiclens (can be purchased over the counter at most pharmacies).
• Nothing to eat or drink (NPO) after midnight the night before your procedure (you may take your morning medications with a small sip of water).
• Please bring a copy of your current medication list to the hospital.

DAY OF PROCEDURE: 

• Report to the Main Registration Desk at El Camino Hospital (you will be notified of any scheduling changes).
  • El Camino Hospital, 2500 Grant Road, Mountain View CA 94040 | (650) 940-7000
• You will be observed for several hours after the procedure and possibly be admitted for overnight observation. Please bring an overnight bag, just in case.
• If you are kept overnight, you will be discharged from the hospital in the morning the next day. Please arrange a ride home from the hospital.

POST-PROCEDURE 

• You will get detailed instructions upon discharge about wound care.
• You should have a post-op appointment scheduled with your electrophysiologist already, about 7-11 days after your procedure.

If you have any questions, please contact our office at (650) 853-2975, Monday-Friday 8:30am-4:30pm.