What is cardiac resynchronisation therapy?
In a healthy heart the walls of the main pumping chamber squeeze together at the same moment. In some people with a weak heart muscle the electrical signal is delayed, so one wall contracts later than the other and the heart pumps inefficiently, rather like rowers who are out of time. Cardiac resynchronisation therapy, often called a biventricular pacemaker, is a small device placed under the skin below the collarbone with fine wires to both sides of the heart. It sends gentle, painless electrical signals that bring the walls back into time with one another.
Why is it done?
It is considered for patients with heart failure whose heart muscle remains weak on the best possible medication and whose electrocardiogram shows a delayed electrical signal. Resynchronising the heart can improve breathlessness and tiredness, allow you to do more, reduce admissions to hospital and, for many patients, improve survival. Some devices also include a defibrillator that can treat dangerous rhythms.
What happens on the day?
You will usually be admitted on the day of the procedure and asked not to eat for several hours beforehand. In the catheterisation laboratory the skin below your left collarbone is numbed with local anaesthetic and you are given medicine to make you drowsy. Through a small cut, thin wires are guided along a vein into the heart under X-ray, one to the right side and one into a vein on the outer surface of the left side. The wires are tested, connected to the device and the device is tucked into a pocket under the skin before the cut is closed with stitches. It generally takes two to three hours.
What to expect afterwards
You stay in hospital overnight, and a chest X-ray and device check are done before you go home. The area will feel bruised and tender for a week or two, and you should avoid lifting your arm above shoulder height, heavy lifting and driving for the period your doctor advises, usually a few weeks. Keep the wound dry until it has healed. The device is checked in the rooms at regular intervals and the settings are fine-tuned; the battery typically lasts several years and is replaced with a simple procedure. Not everyone feels better immediately, and benefit sometimes takes a few months to appear.
Possible complications
Bruising or a collection of blood at the device pocket is the most common problem and usually settles on its own. Infection of the pocket occurs in a small number of patients and may require antibiotics or removal of the device. Occasionally the lung is nicked while the vein is found, causing air to leak around the lung, which may need a drain. A wire can move out of position and need repositioning, or stimulate the diaphragm and cause hiccup-like twitching. Rarely the heart or a vein is injured, causing bleeding around the heart, or a stroke or heart attack occurs. Your cardiologist will go through these risks with you before you consent.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.