Getting a CRT Device For Heart Failure

GETTING A CRT IMPLANTED

The procedure to implant a CRT does not require open heart surgery, and most people go home within 24 hours. Before the surgery, medication may be given to make you sleepy and comfortable. Generally, the procedure is performed under local anesthesia.

GENERAL STEPS OF AN IMPLANT PROCEDURE:

• A small incision, approximately 5 to 10cm long, will be made in yourupper chest area, just below your collarbone.
• Three leads will be guided through a vein into your heart, and the leads will be connected to the CRT device.
• The CRT device settings will be programmed, and the device will be tested to ensure it is working properly to meet your medical needs.
• The CRT device will be inserted beneath your skin, and the incision in your chest will be closed.

After your procedure, you will be given an CRT identification card. Always carry it with you as it contains important information about the implanted device.

Allow yourself a few weeks to get used to your CRT.

It is important to keep your wound dry for the first few days while it heals. Also avoid wearing tight clothing that could irritate your wound. You should not move the affected shoulder too energetically during the first few days so as not to impair the healing process. Avoid lifting heavy objects. Do not make sweeping movements with your arms, as these can cause undesirable tension on the leads. Consult your doctor in case of specific question.

REPLACEMENT PROCEDURE

The CRT device has been developed to let your doctor know when the battery power falls to a low level. As the battery is an inherent component of the CRT device, the entire CRT device must be replaced during a replacement procedure. The surgeon makes an incision over the old scar and removes the old device. The electrodes are fastened securely and, after they have been checked, a new device is connected, tested and inserted into the existing skin pocket. The leads only need to be changed in exceptional cases.

FOLLOW UP CARE AND MONITORING

Your doctor will set follow-up appointments. During such follow-ups, you should not only mention the symptoms that may have occurred during action of the CRT device, you should also take this opportunity to ask any questions you may have and talk about your concerns and potential fears.

The follow-up appointments enable the defibrillator to be thoroughly checked. During these check-ups, your doctor may:

• Monitor the battery status of the CRT device.
• Check the leads to determine how they are working with the CRT and your heart.
• Review and adjust (if needed) your defibrillator settings to ensure they are programmed appropriately for your medical needs.

This is done through a programmer, a small computer kept at your doctor’s office. Your doctor will use the programmer to retrieve information stored in your CRT.

In addition to these appointments, you should call or visit your doctor in specific situations:

• If the scar becomes red, moist or swells.
• In case of an alert (beeping tone): your CRT performs self-checks automatically. The beeping tone lets you know that something needs attention from your doctor. It is designed to get your attention, not to alarm you. If you hear a beeping tone, just contact your doctor for instructions. Should you hear a solid, 10 second tone, it simply means your device came into close contact with a strong magnet and you should move away from the magnet.
• In case of a shock: with current technology, your CRT-D will deliver a shock only if needed. An inappropriate or unnecessary shock is very unlikely. If tachycardia occurs, the CRT-D will first try to stop it as gently as possible. If this is not successful, cardioversion or defibrillation will be carried out.

Some people are unconscious when their CRT-D delivers a shock, but others are not and may be aware of what’s happening. Different people perceive the shock from the CRT-D very differently. The shock can feel like a vigorous or even painful kick in the chest. The muscles in the chest and upper arm may contract so strongly that you jump up in fright. You should not worry about this, as it simply means that the CRT-D is doing its job. People generally regard this action as necessary and comforting. If you receive a shock, anyone touching you may feel the shock as a muscle spasm or a tingle, although it is unlikely. A shock can be startling, but it will not hurt a person touching you.

Shocks may be uncomfortable. It is normal to be concerned about getting a shock but be reassured this can save your life.

Discuss this with your doctor and he/she will provide a detailed plan of what to do should a shock occur.

An example of a shock plan could be:

• If you got one shock, feel ok and don’t have symptoms (i.e you don’t have chest pain, shortness of breath, rapid heartbeat) then you can call your doctor during regular business hours.
• If you passed out or if you have symptoms like chest pain, shortness of breath, lightheadedness/confusion, dizziness, rapid heartbeat or if you got shocked more than once (within 24 hours), get in touch with your doctor immediately or go to the emergency department. If you are followed remotely by a remote monitoring system, you may be asked to send a transmission right then.

Ask your doctor for their recommended shock plan as this may differ between doctors.

Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.