Table of ContentsView AllTable of ContentsHow CRT WorksHow a Biventricular Pacemaker is ImplantedWho Should Consider CRT?Complications of CRTLiving With a Pacemaker
Table of ContentsView All
View All
Table of Contents
How CRT Works
How a Biventricular Pacemaker is Implanted
Who Should Consider CRT?
Complications of CRT
Living With a Pacemaker
Cardiac resynchronization therapy (CRT)is a treatment forheart failuredue todilated cardiomyopathy. Dilated cardiomyopathy is one type of cardiomyopathy, but not the only one for which CRT is a treatment. The treatment involves a special type of pacemaker that coordinates the timing of the ventricles. CRT can bring about dramatic improvements for some people with heart failure, decreasing the need for hospitalization and lowering the risk of death.Having a pacemaker does come with risks and requires regular upkeep, but in most cases the benefits far outweigh any potential complications and minor inconvenience.
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Cardiac resynchronization therapy frequently is used for people with heart failure who have an abnormality in the heart’s electrical conducting system calledleft bundle branch lock (LBBB)in which the right and left ventricles beat out of sync. A third of people with heart failure have LBBB.
CRT involves the implantation of a special device called abiventricular pacemakerthat controls theright and left ventriclesof the heart independently. Typical pacemakers control only the right ventricle.
The pacemaker is surgically implanted under the skin. It has two or three leads (insulated wires that deliver electrical impulses) that are attached to the heart and to a tiny battery-powered computer called a generator. The leads are implanted through a vein in the right atrium and right ventricle and into the coronary sinus vein to pace the left ventricle.
People with heart failure who are also at high risk forsudden cardiac deathdue to dangerously fast heart rhythms may receive a combination pacemaker and implantable cardioverter defibrillator (ICD) device that will deliver a shock to the heart to interrupt a dangerously rapid heartbeat.
All About Pacemakers
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 (IV) 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.
CRT is not appropriate for all people with heart failure. The best candidates are those who have:
People with heart failure who would not benefit from or need cardiac resynchronization therapy include those who have:
Living With Heart Disease
Cardiac resynchronization therapy is safe for most people who need it but since it involves placing a foreign object inside the body there are potential—but rare—risks and complications inherent in both the implantation procedure and afterwards.
During ImplantationBleedingFormation of a blood clotDamage to tendons, muscles, or nervesPuncture of a lung or veinPerforation of or tissue damage to the heartDangerous arrhythmiasHeart attackStroke
Bleeding
Formation of a blood clot
Damage to tendons, muscles, or nerves
Puncture of a lung or vein
Perforation of or tissue damage to the heart
Dangerous arrhythmias
Heart attack
Stroke
Infection
Deterioration of the skin near the implanted device
Irritation or damage electrodes may cause to heart tissue and nerves
Malfunctioning of the device for any reason
Receiving electrical impulses when they are not needed
If you are like most patients who undergo CRT, you’re likely to feel significantly better and have an improved quality of life once your pacemaker has been implanted.However, you will need to take special care of yourself and the device in order to continue to enjoy these benefits.
What to Expect When You Have a Pacemaker
A Word From Verywell
If you have heart failure that is limiting your ability to function normally and you are already receiving aggressivemedical therapy for heart failure, CRT could be a possible treatment that for you. Most people with pacemakers feel much better afterwards and can go on to lead an active life. Talk with your doctor to determine whether CRT is right for you.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fang F, Jie ZY, Xia LX, et al.Cardiac resynchronisation therapy and heart failure: Persepctive from 5P medicine.Card Fail Rev. 2015;1(1):35-37. doi:10.15420/CFR.2015.01.01.35Clarke AL, Goode K, Cleland JGF.The prevalence and incidence of left bundle branch block in ambulant patients with chronic heart failure.Eur J Heart Fail. 2008;10(7):696-702. doi:10.1016/j.ejheart.2008.05.001Henin M, Ragy H, Mannion J, et al.Indications of cardiac resynchronization in non-left bundle branch block: Clinical review of available evidence.Cardiol Res. 2020;11(1):1-8. doi:10.14740/cr989Boston Scientific.How CRTs work.Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263 e421. doi:10.1016/j.jacc.2021.12.012Balla C, Cappato R.When to choose cardiac resynchronization therapy in chronic heart failure: type and duration of the conduction delay.Eur Heart J Suppl.2019;21(Suppl B):B31-B35. doi:10.1093/eurheartj/suz026Hoth KF, Nash J, Poppas A, et al.Effects of cardiac resynchronization therapy on health-related quality of life in older adults with heart failure.Clin Interv Aging. 2008;3(3):553-60. doi:10.2147/cia.s1823Additional ReadingCleland JG, Abraham WT, Linde C, et al.An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure.Eur Heart J.2013;34:3547. doi:10.1093/eurheartj/eht290.Yancy CW, Jessup M, Bozkurt B, et al.2013 ACCF/AHA Guideline for the management of heart failure: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation.2013;128:1810. doi:10.1161/CIR.0b013e31829e8776
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fang F, Jie ZY, Xia LX, et al.Cardiac resynchronisation therapy and heart failure: Persepctive from 5P medicine.Card Fail Rev. 2015;1(1):35-37. doi:10.15420/CFR.2015.01.01.35Clarke AL, Goode K, Cleland JGF.The prevalence and incidence of left bundle branch block in ambulant patients with chronic heart failure.Eur J Heart Fail. 2008;10(7):696-702. doi:10.1016/j.ejheart.2008.05.001Henin M, Ragy H, Mannion J, et al.Indications of cardiac resynchronization in non-left bundle branch block: Clinical review of available evidence.Cardiol Res. 2020;11(1):1-8. doi:10.14740/cr989Boston Scientific.How CRTs work.Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263 e421. doi:10.1016/j.jacc.2021.12.012Balla C, Cappato R.When to choose cardiac resynchronization therapy in chronic heart failure: type and duration of the conduction delay.Eur Heart J Suppl.2019;21(Suppl B):B31-B35. doi:10.1093/eurheartj/suz026Hoth KF, Nash J, Poppas A, et al.Effects of cardiac resynchronization therapy on health-related quality of life in older adults with heart failure.Clin Interv Aging. 2008;3(3):553-60. doi:10.2147/cia.s1823Additional ReadingCleland JG, Abraham WT, Linde C, et al.An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure.Eur Heart J.2013;34:3547. doi:10.1093/eurheartj/eht290.Yancy CW, Jessup M, Bozkurt B, et al.2013 ACCF/AHA Guideline for the management of heart failure: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation.2013;128:1810. doi:10.1161/CIR.0b013e31829e8776
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Fang F, Jie ZY, Xia LX, et al.Cardiac resynchronisation therapy and heart failure: Persepctive from 5P medicine.Card Fail Rev. 2015;1(1):35-37. doi:10.15420/CFR.2015.01.01.35Clarke AL, Goode K, Cleland JGF.The prevalence and incidence of left bundle branch block in ambulant patients with chronic heart failure.Eur J Heart Fail. 2008;10(7):696-702. doi:10.1016/j.ejheart.2008.05.001Henin M, Ragy H, Mannion J, et al.Indications of cardiac resynchronization in non-left bundle branch block: Clinical review of available evidence.Cardiol Res. 2020;11(1):1-8. doi:10.14740/cr989Boston Scientific.How CRTs work.Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263 e421. doi:10.1016/j.jacc.2021.12.012Balla C, Cappato R.When to choose cardiac resynchronization therapy in chronic heart failure: type and duration of the conduction delay.Eur Heart J Suppl.2019;21(Suppl B):B31-B35. doi:10.1093/eurheartj/suz026Hoth KF, Nash J, Poppas A, et al.Effects of cardiac resynchronization therapy on health-related quality of life in older adults with heart failure.Clin Interv Aging. 2008;3(3):553-60. doi:10.2147/cia.s1823
Fang F, Jie ZY, Xia LX, et al.Cardiac resynchronisation therapy and heart failure: Persepctive from 5P medicine.Card Fail Rev. 2015;1(1):35-37. doi:10.15420/CFR.2015.01.01.35
Clarke AL, Goode K, Cleland JGF.The prevalence and incidence of left bundle branch block in ambulant patients with chronic heart failure.Eur J Heart Fail. 2008;10(7):696-702. doi:10.1016/j.ejheart.2008.05.001
Henin M, Ragy H, Mannion J, et al.Indications of cardiac resynchronization in non-left bundle branch block: Clinical review of available evidence.Cardiol Res. 2020;11(1):1-8. doi:10.14740/cr989
Boston Scientific.How CRTs work.
Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263 e421. doi:10.1016/j.jacc.2021.12.012
Balla C, Cappato R.When to choose cardiac resynchronization therapy in chronic heart failure: type and duration of the conduction delay.Eur Heart J Suppl.2019;21(Suppl B):B31-B35. doi:10.1093/eurheartj/suz026
Hoth KF, Nash J, Poppas A, et al.Effects of cardiac resynchronization therapy on health-related quality of life in older adults with heart failure.Clin Interv Aging. 2008;3(3):553-60. doi:10.2147/cia.s1823
Cleland JG, Abraham WT, Linde C, et al.An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure.Eur Heart J.2013;34:3547. doi:10.1093/eurheartj/eht290.Yancy CW, Jessup M, Bozkurt B, et al.2013 ACCF/AHA Guideline for the management of heart failure: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation.2013;128:1810. doi:10.1161/CIR.0b013e31829e8776
Cleland JG, Abraham WT, Linde C, et al.An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure.Eur Heart J.2013;34:3547. doi:10.1093/eurheartj/eht290.
Yancy CW, Jessup M, Bozkurt B, et al.2013 ACCF/AHA Guideline for the management of heart failure: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation.2013;128:1810. doi:10.1161/CIR.0b013e31829e8776
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