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8VgY^VXGZhncX]gdc^oVi^dc I]ZgVen8GI EVi^Zci>c[dgbVi^dc 9g#9^ZiZg7^bbZa!B9 L]Vi^hV]ZVgi[V^ajgZ=;4 L]Vi^h8VgY^VXGZhncX]gdc^oVi^dcI]ZgVen8GI4 Over 2 million people in Germany suffer from HF. The most common symptoms are shortness of breath, reduced exercise capacity and edemas (fluid retention in the spaces between body cells). The causes of HF are diverse. It can develop as a consequence of long-standing hypertension, coronary heart disease (blood flow through the coronary vessels is reduced), damage to the heart valves, and many other health issues. Advanced HF will cause an enlargement of the ventricles (cardiomyophathy). This will often result in abnormalities of the heart‘s electrical system. The contraction becomes irregular (asynchronous), which will further impair the heart‘s pumping function. In most cases treating the underlying disease that led to heart failure in conjunction with a good pharmacological therapy are successful. In certain cases these therapies fail to improve the patient‘s condition and up until recent years a heart transplant was the only remaining treatment option. A medical breakthrough was the development of Cardiac Resynchronization Therapy (CRT), which today is a treatment option for HF. CRT is basically a technological advancement of the pacemaker. For CRT a sensing electrode is placed in the right atrium, and pacing electrodes are inserted not only in the right, but also in the left ventricle. This biventricular pacing will synchronize, i.e. resynchronize, the heart‘s contractions. Cardiac resynchronization therapy can be used in conjunction with an implantable cardioverter-defibrillator (ICD), which can treat, and in some cases even cure, dangerous cardiac arrythmias. ' >ciZgcVa9Zei#Hi#"BVg^Zc"=dhe^iVa7dccq=ZVYE]nh^X^VcEgd[#9g#=#DbgVc!B9 =dlYdZh8VgY^VXGZhncX]gdc^oVi^dcI]ZgVen 8GIldg`4 Similar to a traditional pacemaker implantation a 2-inch long incision is made underneath the left collarbone to uncover a vein. Through this vein an electrode is placed in the right atrium and right ventricle of the heart. A CRT device has an additional electrode that is positioned through the ‘coronary sinus’ in the left ventricle. Now the device is hooked up to the electrodes and implanted under the skin of the chest. Finally the proper function of the pacemaker and the electrodes are tested and the incision is stitched up. During the entire procedure the patient receives a local anesthetic and medication through an IV to help him/her relax. The placement of the third electrode is performed with the help of ultrasonic imaging. This method was improved by the implant specialists at St.-Marien-Hospital, which drastically reduced the duration of the ‘ultrasonic exposure’. Furthermore this method allows a precise surveillance of the heart function during the entire procedure. L]dXVcWZcZÒi[gdb8GI4 Generally the first step to treating heart failure is the treatment of underlying causes for the disease in combination with a pharmacological therapy. If these initial therapies fail to improve the patient‘s condition, and his day-to-day activities are clearly impaired, cardiac resynchronization therapy is recommended. A number of tests are necessary to prepare for this procedure, which you can review with your family physician or cardiologist. If you have any additional question, please feel free to turn to the doctors at St.-MarienHospital. L]^X]iZhihVgZgZfj^gZYWZ[dgZi]Z ^beaVciVi^dcd[V8GIYZk^XZ4 Initially your doctor will assess your condition based on the symptoms you are experiencing, as well as your medical history. In addition you will need to take an electrocardiogram (EKG) and echocardiogram (echo). A chest x-ray is taken to identify fluid accumulation in the lungs and a complete blood work is done. Also, in preparation for the procedure the vein that will be used to insert the electrodes must be examined. In most cases this can be done with an ultrasound exam. If you take the blood thinner ‘Marcumar‘, you or your physician should consult with the implant surgeons at St.-Marien-Hospital before your admission to the hospital. >ciZgcVa9Zei#Hi#"BVg^Zc"=dhe^iVa7dccq=ZVYE]nh^X^VcEgd[#9g#=#DbgVc!B9 ( =dladc\l^aai]^hegdXZYjgZiV`ZVcY]dl adc\Yd>cZZYidhiVn^ci]Z]dhe^iVa4 =dlh]djaY>YZVal^i]bncZleVXZbV`Zg$ YZÒWg^aaVidg4 After you have been admitted to the hospital, your doctor will perform a number of basic tests, prep for the surgery and go over the anesthesia procedures. If a diagnostic assessment has already been completed the therapy can be implemented quickly. The duration of the procedure depends on many different factors. A suitable vein must be found and the electrodes must perform well during the lead function test. Sometimes it is tricky to insert the electrode through the coronary sinus to the left ventricle. Due to the ultrasound method used at St.-MarienHospital this problem however hardly occurs. Taking all these factors into account, a CRT procedure will generally take about 1-2 hours. After the surgery the patient will be moved to the recovery room and after a few hours to the designated hospital room. During the next couple of days hospital staff will check the incision, conduct an echocardiogram and test the pacemaker’s functions. If everything is in order, you can be released from the hospital. The first two weeks you should not use your left arm much and avoid getting your incision wet (shower/bath). Make sure that you are not wearing tight clothing that could chafe the incision. In addition you should avoid wide ranges of motion with your left arm for about four weeks. After four weeks you may return to your ‘normal’ daily life. Should redness, swelling or wetness around the incision occur, contact your physician or the St.-MarienHospital. Please read the attached manufacturer‘s brochure for general recommendations and precautionary measures in regards to your pacemaker implant. ) >ciZgcVa9Zei#Hi#"BVg^Zc"=dhe^iVa7dccq=ZVYE]nh^X^VcEgd[#9g#=#DbgVc!B9 Your CRT-Team: Dr. Christian Jörgens, MD, Dr. Harald Schmidt, MD, Dr. Dieter Bimmel, MD, Prof. Dr. Heyder Omran, MD, Dr. Stephan Frede, MD 8deng^\]i/Egd[#9g#=#DbgVc!B9VcYVhh^hiVcihWnXdjgiZhnd[BZYidc^X!Hi#?jYZVcY7^digdc^X Hi#"BVg^Zc"=dhe^iVa 9ZeVgibZcid[>ciZgcVaBZY^X^cZ WV YZ =ZVYE]nh^X^VcEgd[#9g#=ZnYZgDbgVc!B9 HeZX^Va^hi[dg^ciZgcVabZY^X^cZVcYXVgY^dad\n =neZgiZch^dad\^hi c^X 67"6W[V]gi 7C"EdeeZahYdg[ ch ig# g# "Hi jhi j\ 6 " ch bZ 8aZ =W[ hi^ V ] hi Zg ji GZ Hig# gZg Ig^Z Z\ Yl g# ?V\ ig# g"H ghi ]V Adi Gd ZaVc 6g\ hig# YZg g# >ee Gi ZcYdg i\Z [$ c i g\h Wj ZaZ io dX]"Hig# gi"@ #"A ^cg i WZ Zc gc HiZ Zg \ ^c L =Z >b GdWZgi"@dX]"HigVhhZ& *(&&*7dccKZcjhWZg\ E]dcZ/ ).''-*%*"'&%& ;Vm/ ).''-*%*"'&%' :bV^a/ ^ccZgZBZY^o^c5bVg^Zc"]dhe^iVa"Wdcc#YZ lll#bVg^Zc"]dhe^iVa"Wdcc#YZ HZ :c g# K Jc Zcj ^"@ hWZ a^c g\ ^`Z $ c c^X]$ @ZhhZ dYZhWZg\ 7VY< # "Hig Zg\ Cdc"egdÒidg\Vc^oVi^dcd[i]Z Æ;gVcX^hXVcH^hiZghÆd[DaeZ W [Zc Vj[ ["Hi <gV '&/ Hi#"BVg^Zc"=dhe^iVa