Dr Vanita Arora - A Patient’s Guide for Heart Failure

“Cardiac Re-synchronization therapy, an upgraded and smaller version of a pacemaker results in better quality and in some cases heals the organ before damage occurs”, says Dr VanitaArora.

Chronic Heart Failure (CHF) occurs when the heart is unable to pump enough blood to sustain adequate circulation in the body’s tissues. CHF affects more than 22 million people worldwide, a potentially debilitating disease and is the only major cardiac disorder that is steadily increasing. The patient complains of fatigue, shortness of breath (Dyspnoea), swelling of feet and ankles (Edema) and is unable to perform day to day activities. Once heart failure is diagnosed, prognosis is poor. Read More: (A Patient’s Guide for Heart Failure )

Until recently, lifestyle changes, medication and at times, heart surgery were the only treatment options. Patients with severe symptoms, however, receive little, if any, relief from such approaches. But for a failing heart, a transplant surgery is the only option. However, the surgery is not practical as it is not practical to find hearts which can be transplanted. To make matters worse, upon 40 per cent patients with CHF also have an Arrhythmia that further reduces the heart’s ability to bet properly.

Causes of heart failure

The heart acts like a pump, where all four chambers of the heart beat in an organized way. Between each beat of the heart, the chambers of the heart fill up with blood. When the heart beats of contracts, it squeezes blood out of it chambers and pushes the blood through your body.

It is a coordinated and synchronized motion of all four chambers of the heart which is needed for the body to get adequate supply of blood.

A patient with heart failure has problems with the Electrical system. The synchronization of two lower pumping chambers is compromised by a condition known as Bundle Branch Block (BBB). It occurs when the conduction of the electrical impulse to the ventricles is blocked or slowed down. The causes the main pumping chambers of the heart, to become “out of sync”.  When the heart loses its coordination, it compromises its pumping action. This limits the supply of fresh, oxygenated blood that the body as well as the heart itself needs. The heart slowly gets weaker and the heart muscle thins out and the heart size increases, which worsens the overall situation.

How does Cardiac Re- synchronization Therapy (CRT) Work?

This is an innovative therapy that can relieve CHF symptoms by improving the coordination of the heart’s contractions. A CRT pacemaker is a more advanced version of the standard pacemaker. It’s about the size of the pocket watch, and once implanted in the chest improves the coordinated contraction pattern in the left ventricle improving the overall efficiency of the heart.

In addition to the two leads (right atrium and right ventricle) used by a common pacemaker, the CRT device has a third lead that positioned in a vein on the surface of the left ventricle.

The device is implanted beneath the skin, usually below the collarbone. The CRT pacemaker sends out electrical pulses to the heart through the leads. These electrical impulses get the heart’s pumping coordinated again. This allows the CRT device to simultaneously stimulate the left and right ventricles and restore a coordinated, or “synchronous,” squeezing pattern. This is sometimes referred to as “bi-ventricular pacing” because both ventricles are electrically stimulated (paced) at the same time.

CRT is recommended for people with severe symptoms of Dyspnoea or for the patient, who is on the maximum tolerated doses of medications.

The therapy is right for….

There is difference between traditional pacemakers and pacemakers that are designed to treat heart failure. Traditional or standard pacemakers are used to help people with a slow heartbeat. They have two leads going, one to upper chamber and one to the lower one in the heart. Traditional pacemakers don’t coordinate (re- synchronize) the main pumping chamber of the heart (the left ventricle). CRT, on the other hand is more sophisticated and technically advanced than a conventional pacemaker.

The ideal candidate for CRT device is someone with: moderate to severe CHF symptoms, despite lifestyle changes and medication.

Heart failure patient who do not have synchronous beating in the heart’s lower chambers and decreased heart function, too are at a high risk of sudden cardiac arrest. For these patients, a special CRT device is implanted which can stop potentially life-threatening rapid heartbeats by delivering an electrical shock (defibrillation). This device incorporates a standard implantable cardioverter defibrillator (ICD) with a CRT pacemaker creating a “CRT-D” device/COMBO device.

Benefits of CRT

The patients with heart failure feel tired, sick, and short of breath. CRT pacemakers may make one feel healthier and energetic. Physical activity becomes easier. Many studies conducted to determine the safety of CRT have shown that this device is well accepted by the patients.

Also, the patients suggest that the device improves their quality of life. Heart failure can make the heart dilate or grow larger. When this happens, the heart becomes weaker thus making symptoms worse. Some studies have shown that CRT pacemakers can slow or stop this process. Over time, CRT pacemakers can even help the heart get back to its normal size. They can reverse some of the damage caused by heart failure.

CRT Results

The response to CRT can vary greatly from patient to patient. Clinical studies involving more than 2000 patients worldwide demonstrate modest improvements in exercise tolerance, CHF severity, and quality of life. Time for actual improvement may vary from a few days to several months.

CRT pacemakers are a big step forward for many people living with heart failure and have proved to be a miracle therapy for many living with severe conditions of heart failure. Thousands are living a healthier and happier life due to this device.

Dr.Vanita Arora is Sr. Consultant Interventional Cardiologist & Eletrophysiologist Escorts Heart Institute and Research Centre.