Download Cardiac Resynchronization Therapy (CRT)

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
GŽi 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