CRT or "bi-V"

Olga Voroshilovsky, MD Cardiology / Cardiac Electrophysiology

Who needs CRT or "bi-V" pacing therapy? Patients with symptomatic heart failure (shortness of breath, leg swelling, etc.), low heart function (ejection fraction (EF) <40%), and specific pacing parameters (expected pacing in the ventricle, LBBB (left bundle branch block)).
Will it have an ICD? CRT or "bi-V" therapy can be used with both pacemakers or ICDs depending on the indication and discussion with your doctor regarding goals of care.
How is a CRT device implanted? The same techniques are used as for pacemaker/ICD implantation. But an additional wire (lead) is placed within a vein (coronary sinus) from inside the heart. The wires are then is attached to the device and placed under the skin. The skin is then closed with sutures.
Will I be asleep for the surgery? Yes, deep sedation is provided by an anesthesiologist during the procedure.
How long does the surgery take? Typically, surgery takes about 2 hour. Total time including preparation and recovery is usually 3.5 hours once the patient goes into the operating room.
When will I go home after surgery? Most patients go home the morning after their procedure.
Will I have pain after the procedure? Some pain is normal and usually controlled with extra strength Tylenol. Occasionally stronger medications, such as Tylenol with Codeine are needed for the first 2-3 days after surgery.
When can I return to work? Depending on the type of work done, usually within 2-3 days unless your job requires strenuous activity.
When can I drive? When your pain is contolled does not limit motion of your arm unless you have a history of passing out, in which case this will be evaluated in follow-up.
What kind of follow-up do I need? You will be seen 1 week after implantation to make sure your incision is healing well and again 1 month after surgery. After that pacemakers are checked every 6 months and ICDs every 3 months.
How long do CRT devices last? Pacemaker CRT longevity is usually 6-10 years and ICD CRT devices last 4-8 years. When the battery reaches replacement time this is usually done as a relatively simple outpatient procedure.
How is the ICD checked? A wand is placed over the device which allows it to communicate with the programmer. Battery life, device settings, and stored rhythms can be checked and adjusted in this way. Some devices are also able to communicate wirelessly.