Biventricular Pacemaker

A biventricular pacemaker, also known as a cardiac resynchronization therapy (CRT) device, is a type of pacemaker used to treat certain heart conditions, particularly heart failure. It helps improve the heart's efficiency by ensuring that both the left and right ventricles (the heart's lower chambers) beat in sync. This is crucial in patients whose heart's electrical system isn't functioning properly, causing the heart chambers to beat out of sync, which can lead to inefficient pumping and worsened symptoms.

The device works by sending electrical impulses to both the right and left ventricles, helping them contract together in a coordinated manner. This is particularly helpful for people with heart failure and those who have abnormal heart rhythms (arrhythmias).

CRT has been shown to improve symptoms like fatigue, shortness of breath, and exercise tolerance, and it can also reduce hospitalizations and improve survival in certain patients.

How a Biventricular Pacemaker Works

1. The Electrical Problem in Heart Failure:
   In some people with heart failure, the electrical signals that control the heart’s beat get delayed or uncoordinated, causing the ventricles to contract at different times. This leads to inefficient pumping, worsening heart function and contributing to symptoms like fatigue, fluid retention, and difficulty breathing.

2. Synchronization of Heartbeats:
   A biventricular pacemaker, or CRT device, aims to resynchronize the heart. The device is implanted under the skin, typically near the collarbone, and has three leads (wires):

   • One lead goes into the right atrium to monitor and pace the upper part of the heart.

   • One lead goes into the right ventricle to help regulate its beat.

   • A special third lead is placed into the left ventricle, usually through a vein on the heart’s surface, to help stimulate it to beat in sync with the right ventricle.

3. Improved Coordination:
   By sending signals to both the left and right ventricles, the device helps ensure that both chambers of the heart contract simultaneously, improving the heart's pumping efficiency. This helps the heart pump blood more effectively to the body and lungs.

Benefits of CRT

• Improved Heart Function: By resynchronizing the ventricles, CRT can improve the heart's pumping ability and enhance overall heart function.

• Symptom Relief: Patients often experience a reduction in symptoms such as shortness of breath, fatigue, and swelling in the legs.

• Improved Quality of Life: Many people notice a significant improvement in daily activities and energy levels.

• Reduced Hospitalizations: It can help reduce the frequency of heart failure-related hospital stays.

• Survival Benefit: In some patients with advanced heart failure, CRT can improve survival rates.

Implantation Process

The procedure to implant a biventricular pacemaker is typically done under local anesthesia and light sedation, although general anesthesia may be used in some cases. It usually takes a few hours and involves:

• Making small incisions near the shoulder.

• Inserting the leads into the heart through blood vessels (using X-ray guidance).

• Testing and adjusting the device to ensure it’s working correctly.

• The device is usually placed in a small pocket under the skin near the collarbone.

After the Implantation

• Follow-Up Appointments: Patients need regular follow-up appointments to check the device’s function, battery life, and settings. This can sometimes be done remotely via a home monitoring system.

• Recovery: Most people can resume normal activities in a few weeks, although they should avoid heavy lifting or strenuous exercise initially.

• Lifestyle Adjustments: While the device helps manage heart failure symptoms, patients may still need to follow a heart-healthy lifestyle and take medications as prescribed.

Risks and Considerations

As with any surgery, there are risks:

• Infection at the site of implantation

• Lead dislodgement or malfunction

• Device-related complications, such as a problem with battery life or improper pacing

• In some cases, patients may experience minor side effects from the device, like a sensation of pacing or unusual rhythms

But, overall, for patients who meet the criteria, CRT can be a game-changer in managing heart failure and improving life quality.