What Is a CRT-D?
A CRT-D is an implantable cardiac resynchronization therapy (CRT) defibrillator for patients with heart failure. The device monitors the heart's rhythm, detects irregularities and corrects them with electrical impulses. Like an implantable defibrillator (ICD), a CRT-D is designed to stop life-threatening ventricular tachycardia and fibrillation with relatively weak and painless stimulation therapy or electrical shocks. CRT-Ds differ from ICDs in that they help your heart’s lower chambers – the ventricles – work in tandem. To do this, CRT-Ds have three leads – wires that deliver energy to the heart – rather than one or two, as in an ICD. A CRT-P is a cardiac resynchronization therapy pacemaker that does not have the defibrillation capabilities of a CRT-D. CRT-Ds enhance diseased hearts’ effectiveness and increase blood flow. They improve heart failure symptoms like fatigue, shortness of breath and exercise intolerance. Cardiac resynchronization therapy significantly lowers the risk of life-threatening cardiac events. Many patients’ quality of life improves significantly with a CRT-D. Surgery is necessary to implant a CRT-D.
Your physician will give you detailed instructions about how to prepare for the surgery. Usually, you will be advised to stop taking blood-thinning medication several days before surgery. If you take other medication regularly, ask your physician if you should continue taking the medication before your procedure. In addition, you should not eat for about 12 hours prior to the implantation.
The procedure to implant a CRT-D is relatively simple and usually lasts two to four hours. It is not open-heart surgery. You will receive antibiotics to reduce the risk of infection. The intervention will be performed under local anesthesia, and sometimes, short-term sedation.
After preparing the incision site, the surgeon will make a small cut in your upper chest, well below your shoulder. The surgeon will insert three leads into a major vein near your collarbone. Using X-ray for visibility, the surgeon will guide the leads through your veins and place them in your heart’s upper and lower chambers. Then, the surgeon will implant the CRT-D in a pocket created at the incision beneath the skin. The surgeon will connect the leads to the defibrillator and program it to your specific medical needs. After a test to ensure that the CRT-D is working correctly, the surgeon will close the incision with a few stitches.
Usually, you will stay in the hospital for one to two days after the implantation. Listen carefully to your physician and follow their instructions.
At home, monitor how the incision is healing. Your arm’s range of motion will probably be limited until the wound is completely healed. In some patients, the CRT-D forms a small, visible bulge underneath the skin. Most patients get used to it quickly and soon cease to notice it.
Magnetic fields and electromagnetic radiation can influence your CRT-D’s functionality. Please ask your physician about which kinds of devices may affect your CRT-D and how to avoid them, and consult the patient brochure you will receive from your physician. New BIOTRONIK CRT-Ds include ProMRI® technology. Check whether your device is approved for magnetic resonance imaging (MRIs) here. Always carry your patient identification card on you. In the case of a medical emergency, it prevents physicians from running tests and doing procedure that will interfere with your device.