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Congestive Heart Failure Cardiac Resynchronization Therapy

When Can I Do Normal Activities After A Pacemaker Implantation

Congestive Heart Failure & Atrial Fibrillation

After your pacemaker is implanted, you may move your arm you don’t have to restrict its motion during normal daily activities. Avoid extreme pulling or lifting motions . Activities such as golf, tennis, and swimming should be avoided for six weeks from when the pacemaker was implanted. Microwave ovens, electric blankets, and heating pads may be used. Cellular phones should be used on the side opposite your pacemaker. Ask your doctor or nurse for more specific information regarding what types of equipment may interfere with your pacemaker.

Pacemaker Identification: You will receive a temporary ID card that tells you what type of pacemaker and leads you have, the date of implant and the doctor who implanted it. In about three months following implantation, you will receive a permanent card from the company. It is important that you CARRY THIS CARD AT ALL TIMES in case you need medical attention at another hospital.

Description Of Included Studies

All nine of the trials enrolled only patients with prolonged QRS duration: > 120 millisecond in three trials,> 130 msec in two trials,> 140 msec in one trial,> 150 msec in one trial,> 180 msec in one trial, and > 200 msec in the remaining trial. Left bundle branch block was present in 64 percent of patients, and 95 percent of patients were in sinus rhythm. All trials also restricted enrollment to patients with reduced ejection fractions , and the mean ejection fractions were similar in all trials .

In total, 3,574 patients were enrolled and 3,216 were randomized to receive CRT or control in the nine trials. The mean age was 64 years, 74 percent were male, 75 percent had NYHA Class III symptoms, and 10 percent had NYHA Class IV symptoms. Two trials included some patients with NYHA Class II symptoms., Most of the patients in these trials had ischemic etiologies for their heart failure .

Including the nine additional singlearm prospective cohort studies, a total of 3,512 patients who had undergone CRT implantation were included in the safety analyses.

Congestive Cardiac Failure: What Is Cardiac Resynchronization Therapy

Do you want to know what Cardiac Resynchronization Therapy is? Do you know exactly how your heart functions? It works in a rhythm. It beats 60 to 100 times per minute, and when it beats, it pumps oxygenated blood to your whole body. When the heart relaxes immediately after each beat, impure blood reaches your heart. The heart then sends the same impure blood to your lungs for purification. The purified blood then reaches your heart, where it is pumped and transferred to the whole body. There also comes a situation when the heart is not able to pump enough blood or when the demand doesnt match the supply, and this situation is usually referred to as heart failure.

Acquainting you with another term called “arrhythmia,” is also important. An arrhythmia hints to irregular heartbeats and is a condition where your heart beats irregularly and unpredictably. Usually the heart beats faster when you are exercising or running, and it beats slower while you are asleep or resting. Hence, any irregularity in the beating of your heart when youre completely relaxed and not exercising or sleeping can cause arrhythmia, which must be reported accurately to the doctor or specialist, who will give you better knowledge on how to deal with it.

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What Happens During Insertion Of A Crt Device

Your doctor may Insert your CRT device on an outpatient basis, or as part of your stay in a hospital. Procedures may vary, depending on your condition and your doctor’s practices. Talk with your doctor about what will happen during your procedure.

The actual procedure may take from 3 to 5 hours. Youll probably be awake but relaxed and sleepy during the procedure. This is what you can expect:

Are There Risks Involved

Heartlines  Volume 2, Issue 3  Cardiac Resynchronization Therapy

Like any medical procedure, CRT implantation carries some risks. But complications such as bleeding or infections are unusual. In rare cases, the therapy can trigger an arrhythmia.

Mechanical problems, such as a lead coming loose or the device not sending impulses properly or consistently, can sometimes occur. As a result, you may need a second procedure to replace the device or lead. In general, though, CRT is considered a safe, low risk treatment for appropriate individuals.

The device should also be implanted only if your doctor believes it will provide a significant improvement. Some people with heart failure are too weak or ill to undergo the procedure and benefit from resynchronization therapy.

If you have HFpEF, or there are no arrhythmias detected with your type of heart failure, CRT should not be a consideration.

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Who Is A Candidate For Crt

In general, CRT is for heart failure patients with moderate to severe symptoms and whose left and right heart chambers do not beat in unison. However, CRT is not effective for everyone and is not for those with mild heart failure symptoms, diastolic heart failure or who do not have issues with the chambers not beating together. It is also not suitable for patients who have not fully explored correcting the condition through medication therapies. To date, studies show CRT to be equally effective for both men and women.

Your Beat Monitored Remotely

There are more ways to allow you to live life to the fullest. Remote monitoring of your Abbott implanted CRT heart device may help you do just that, and it gives you and your doctor the feeling of safety and security of continuous monitoring of your heart from the time of implant to the time you are at home.

With remote monitoring, your CRT device is able to communicate to your doctor’s office or clinic without you having to go in for an in-person visit. Your doctor may schedule your in-person visits less frequently, based on the data they receive from your device.

After your CRT device is implanted, you will use either a transmitter or downloadable mobile app to transmit information to your doctor.

Indications, Safety & Warnings

Rx Only

Brief Summary: Prior to using these devices, please review the Users Manual for a complete listing of indications, contraindications, warnings, precautions, potential adverse events and directions for use.

Refer to the Users Manual for detailed indications, contraindications, warnings, precautions and potential adverse events.

MAT-2115398 v1.0

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How Do I Prepare For The Biventricular Pacemaker Implant

Ask your doctor what medications you are allowed to take before your pacemaker is implanted. Your doctor may ask you to stop certain drugs several days before your procedure. If you have diabetes, ask your doctor how you should adjust your diabetic medications.

Do not eat or drink anything after midnight the night before the procedure. If you must take medications, drink only small sips of water to help you swallow your pills.

When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry and valuables at home.

How A Biventricular Pacemaker Is Implanted

Living with Heart Failure treated with Cardiac Resynchronization Therapy (CRT)

If you are receiving a pacemaker, it will likely be implanted during a three-to-five hour out-patient procedure. You will be awake but given medication to numb the area where the device will be placed and to keep you sleepy and comfortable. An intravenous line will deliver pain medication, fluids, and antibiotics.

To implant the pacemaker, the healthcare provider will make a small incision just below your left collar bone to create a “pocket” that will hold the wires and computer battery pack. They will place the electronic leads into the large vein that feeds the heart. Special X-rays will be taken to make sure the leads are positioned correctly on each side of the heart.

Once the leads are placed, the healthcare provider will test the CRT with an electric pulse that may make you feel as if your heart is racing. Once the leads are working correctly, they are attached to the pacemaker which is placed under your skin.

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Structure Of Decision Model

The primary analysis considered patients with NYHA Class III symptoms. The analysis considered the lifetime horizon and employed a statetransition Markov model with a cycle length of 1 month. During each cycle, patients who received medical therapy could die of unrelated causes, die of cardiovascular disease, be hospitalized for heart failure, or remain stable. Patients who underwent insertion of a device capable of CRT could die during the initial implantation of the device or experience lead infection, lead failure, battery failure, or any of the health states associated with medical therapy for heart failure.

What Happens After The Pacemaker Is Implanted

Hospital stay: After the pacemaker implant, you will be admitted to the hospital overnight. The nurses will monitor your heart rate and rhythm. You will also have a monitor . It will record your heart rhythm while you are in the hospital. This is another way to check proper pacemaker function. The morning after your implant, you will have a chest X-ray to check your lungs and the position of your pacemaker and leads. Your pacemaker will be checked to make sure it’s working properly. The results of the test will be reported to your doctor.

Final pacemaker check: For your final pacemaker check, you will sit in a reclining chair. A small machine known as a programmer is used to check your pacemaker. It has a wand that is placed directly over the device. This machine allows the technician to read your pacemaker settings and make changes during testing. With these changes, the function of the pacemaker and leads can be evaluated. You may feel your heart beating faster or slower. This is normal however, report all symptoms to the technician. Results of the pacemaker check are discussed with your doctor who will then determine your pacemaker settings.

After your pacemaker check, an echocardiogram may be done. The technician nurse will be there during your echo and will check your pacemaker settings. The echocardiogram will be repeated with each setting to evaluate heart function. The pacemaker will keep the settings that were associated with your best heart function.

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Relationship Between Mechanical And Electrical Resynchronization

The concepts of mechanical and electrical remodeling refer to two distinct concepts: the first one is the mechanical improvement of the heart, and the second one is the electrical changes that tend to produce a less variegated electrical pattern.

This mechanical remodeling of the heart has already been observed previously in patients with optimal treatment for heart failure. Cardiac resynchronization produces a level of inverse echocardiographic remodeling added to that achieved with appropriate pharmacologic therapy . On an anatomopathologic level, there is a decrease in the degree of myocardial fibrosis .

At the present time, the decision to implant a CRT device is based on clinical and electrocardiographic data and not on echocardiographic criteria. Sporadic cases have described the benefit of CRT in patients with dyssynchrony and a narrow QRS, with improvement of LV function however, this has not gained universal acceptance.

Many studies define the relationship between a reduction in left ventricular endsystolic volume of at least 10% and a reduction in the width of the nonstimulated QRS and the stimulated QRS after implantation . These data point at the same direction that those from other studies and heighten the importance of placing the left ventricular electrode in the appropriate site and of properly programming the device, to achieve a narrowpaced QRS complex.

What Happens During The Pacemaker Implantation

Cardiac Resynchronization Therapy (Sep 19 2007)_(1841846376)_(CRC Press ...

Pacemakers can be implanted two ways:

Inside the Heart : This is the most common technique used. A lead is placed into a vein , and then guided to your heart. The tip of the lead attaches to your heart muscle. The other end of the lead is attached to the pulse generator, which is placed under the skin in your upper chest. This technique is done under local anesthesia .

Outside the Heart : Your chest will be opened and the lead tip is attached to the outside of the heart. The other end of the lead is attached to the pulse generator, which is placed under the skin in your abdomen. This technique is done under general anesthesia by a surgeon. This is typically performed in conjunction with open heart surgery being performed for another reason.

Your doctor will decide which approach is best for you, although almost all patients receive the transvenous approach.

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Eligible Patients And Other Issues For Crt Application

A key issue for CRT is the identification of eligible patients who are most likely to respond and receive the most benefit. QRS duration has been deemed a primary variable as a principal electrical marker of spatially dispersed mechanical activation thus, patients with wider QRS complexes seem to have a greater mechanical response to CRT. In addition, the worse the ventricular dysfunction, which probably reflects the degree of dyssynchrony, the greater the response to CRT.

The percentage of

How Cardiac Resynchronization Works

Nearly one third of people with congestive heart failure have lower heart chambers, called ventricles, that do not pump in unison. This issue worsens the function of an already damaged heart.

Cardiac resynchronization therapy uses a small device called a biventricular pacemaker implanted under the skin just below the collarbone. It produces electrical pulses to stimulate the heart muscles to pump at the same time.

Some CRT devices have a built-in defibrillator. The implantable cardiac defibrillator detects dangerous, fast heartbeats and sends an electric pulse to restore a normal rhythm.

Youll receive personalized cardiac resynchronization therapy customized for the best possible results.

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Who Is A Candidate For A Biventricular Pacemaker

Biventricular pacemakers improve the symptoms of heart failure in about 50% of people that have been treated with medications but still have significant heart failure symptoms. Therefore, to be eligible for the biventricular pacemaker, heart failure patients must:

  • Have heart failure symptoms
  • Be taking medications to treat heart failure
  • Have the type of heart rhythm problems mentioned above

In addition, the heart failure patient may or may not need this type of pacemaker to treat slow heart rhythms and may or may not need an internal defibrillator , which is designed to treat people at risk for sudden cardiac death or cardiac arrests.

What To Expect After Cardiac Resynchronization Therapy

Cardiac Resynchronization Therapy Rescues Cancer Survivor from Heart Failure

A CRT pacemaker battery can last up to 8 years. Your doctor will be able to tell months before the battery is likely to run out so that you can schedule a replacement procedure.

You will also need to carry a CRT identification card to let all other doctors know your status. Its also helpful if you need to go through a metal detector at the airport or other locations.

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Assumptions In Decision Analysis

A number of assumptions were necessary because of the paucity of several pieces of data. First, it was assumed that unit costs of heart failure therapy were identical between medical therapy and CRT. Second, it was assumed that the incidence of complications associated with CRT was constant over time. However, since the duration of followup in each trial was relatively short and the incidence of adverse effects in these trials was higher than generally accepted for ICD implantation, the researchers considered lower incidences of device or devicerelated adverse effects than observed in the trials in the sensitivity analyses. Third, it was assumed that any mechanical malfunction of the device required battery replacement with consequent costs. Finally, agespecific mortality due to unrelated causes was based on life tables.

What Are The Advantages Of Crt

CRT shows significant improvements in heart failure patients, wherein medicines are not able to control the symptoms. CRT helps in:

Improved efficiency of the heart by correcting abnormal rhythms: the pacemaker helps widely in ensuring that your heart beats correctly.

Improvement in heart failure symptoms: as the efficiency of the heart is improved, some of the symptoms of heart failure are also improved.

Reduced hospitalization

Increased exercise capacity and allowing individuals to resume many daily activities

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Who Is Best Suited For Crt

CRT is especially indicated for moderate to severe heart failure patients whose left and right side of the heart do not beat in unison. CRT is specifically indicated for those who belong to Class III and Class IV classification by New York Heart Association .

Breathlessness, swelling, coughing, and tiredness are some of the symptoms of heart failure. An individual must always take notice of how his body functions, and, if he experiences symptoms with ordinary activities, he falls in Class III, whereas if he experiences severe limitation and experiences symptoms of heart failure even at rest, he may then belong to class IV. Whatever be the classification and category under which he may fall, he must always ensure to make a note of his condition and side effects that must be reported as soon as possible to the doctor, who can suggest the best medication and treatment before the condition worsens with time.

CRT is indicated in patients cardiomyopathy or weak heart muscles, as well.

CRT is not indicated in the following cases:

CRT may not work for mild heart failure patients.

CRT may not work for those who have no issue with the left and right sides of the heart not beating in unison.

CRT wont work for diastolic heart failures.

Who Is A Right Candidate For Crt


When we are talking about who is the good candidate for congestive heart failure cardiac resynchronization therapy, those who have moderate to serve symptoms of heart failure, and whose left and right heart chambers do not beat in unison.

Experts say that CRT is not effective for every patient and it is not for those who do not have issues with the chambers not beating together, mild heart failure symptoms, or diastolic heart failure. In studies till now, CRT to be equally effective for both men and women.

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