CRT in Heart Failure
Heart failure is a chronic condition that affects the heart's ability to pump blood. Despite advances in medical therapy, heart failure remains a major cause of morbidity and mortality worldwide. Cardiac resynchronization therapy (CRT) has emerged as an important treatment option for certain patients with heart failure, especially those with a reduced left ventricular ejection fraction (LVEF) and left bundle branch block (LBBB).
LVEF is a measure of how much blood the left ventricle pumps out with each contraction. It is expressed as a percentage, and a normal LVEF is usually greater than 50%. In heart failure, the LVEF is typically reduced, meaning that the heart is not pumping as effectively as it should be. Patients with LVEF less than or equal to 35% and symptoms of heart failure (NYHA class II-IV) are considered for CRT.
LBBB is a type of heart rhythm disorder that occurs when there is a delay or blockage in the electrical signals that travel through the heart's ventricles. This can lead to an asynchronous contraction of the heart muscle, which can further impair its pumping function. CRT is designed to coordinate the contractions of the heart's chambers, which can help improve its overall pumping function and reduce symptoms of heart failure.
The implantation of a biventricular pacemaker typically involves a minimally invasive surgical procedure, which is performed under local anesthesia. The pacemaker is usually placed under the skin of the upper chest, with leads (wires) threaded through the veins into the heart. One lead is placed in the right atrium, one in the right ventricle, and one in the coronary sinus vein, which is located on the outside of the heart. The coronary sinus lead is positioned to stimulate the left ventricle and help coordinate its contractions with the right ventricle.
Numerous studies have shown that CRT can improve symptoms of heart failure, reduce hospitalizations, and prolong survival in selected patients. However, as with any medical procedure, there are risks associated with CRT, including infection, bleeding, and complications related to the placement of the pacemaker leads. In addition, not all patients will experience significant benefits from CRT, and some may experience side effects such as discomfort or muscle twitching.
In conclusion, CRT is an important treatment option for certain patients with heart failure who have reduced LVEF and LBBB. It involves the implantation of a biventricular pacemaker, which can improve the coordination of the heart's contractions and reduce symptoms of heart failure. If you or a loved one has heart failure with reduced LVEF and LBBB, talk to your doctor to see if CRT may be an appropriate treatment option.
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