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Cardiac Resynchronization Therapy

cardioversioncatheter ablation (including radiofrequency and cryoablation)
implantable cardioverter defibrillator (icd)Cardiac Resynchronization Therapypermanent pacemaker
Stereotaxis3-D Electrophysiologic Mapping

1. Why did my doctor order cardiac resynchronization therapy (CRT)?
Your heart has an electrical system that helps it beat at a regular speed or pace. If you have an abnormally slow heartbeat that is caused by the heart’s lower chambers beating out of sync, your doctor may recommend a biventricular pacemaker. Unlike a traditional pacemaker, biventricular pacemakers connect to both of the lower chambers to resynchronize the heartbeat. Thus, the treatment is called cardiac resynchronization therapy or CRT.

CRT is also an effective treatment for patients with an enlarged heart muscle, a condition referred to as cardiomyopathy.

2. How does a biventricular pacemaker work?
A biventricular pacemaker has three parts: a generator, housed in a smooth, lightweight case that contains a tiny computer and battery which makes electrical signals when they're needed (You won't feel the electricity coming out of the generator.); the connectors, which are part of the generator where the lead or leads are attached; and the leads, two thin wires covered by soft, flexible plastic, that help the generator listen to the heart and carry the generator's signals to the heart.

3. What preparations will I need to make?
You will be admitted to the hospital on the day of the procedure. Your doctor will tell you not to take aspirin or other medications that day. You will also be asked to fast for six hours prior to the implantation. Before you are taken to the operating room, the skin where the pacemaker is implanted will be washed and may be shaved. You may also be given a mild sedative to help you relax.

4. How is the biventricular pacemaker implanted?
Biventricular pacemaker implantation is not open-heart surgery. It's a minor procedure that's done in the operating room or cardiac catheterization lab.

You will receive an injection of a local anesthetic to numb the insertion area. Since you will be awake during the procedure, you may be asked to assist the physician by taking deep breaths. An incision will be made in your skin below your collarbone. (Pacemakers can be inserted on either the right or left side. You may want to discuss your preference with your physician.) The leads are threaded through the incision into a vein in your upper chest. Using x-ray monitors, the leads are then guided into your heart's chambers. Electrical measurements are taken to determine a good position for the leads in the heart. At this point, the generator is attached to the leads and is placed under the skin. Your doctor will then close the incision.

5. How long will the procedure last?
The procedure may last two to three hours.

6. What will the recovery be like?
You will stay in the hospital a day or two to make sure the biventricular pacemaker is working properly. Your pulse, blood pressure and incision will be checked regularly by a nurse. You will be asked not to lift your arm above your shoulder on the pacemaker side so that the leads will have a chance to secure themselves inside the vein and your heart. During the first 24 hours following implantation, be sure to lie only on your left side while resting or sleeping. This, too, will help the leads secure themselves. You may experience some stiffness and pain in the incision area, for which you will receive medication.

When you return home, you can continue with your daily activities. Remember to take it easy to keep from pulling the leads out of place. Avoid lifting your arm over your head for at least a week, and avoid heavy lifting, running and playing contact sports until your doctor says it's safe to resume those activities. Take your temperature every day for a week (it should be normal) and check your incision for signs of infection, such as redness, swelling, drainage, pain and if the area is warm to the touch. Notify your doctor if any of these signs appear. You may need to schedule a doctor's visit to have your sutures or staples removed. Your incision should heal completely within a month.

7. What happens after the biventricular pacemaker is implanted?
Your physician may ask you to check your pulse regularly and to check your pacemaker by sending signals to your doctor's office by phone. Biventricular pacemaker batteries, which are located in the generator, need to be replaced every five to 10 years. (Don't worry, the batteries won't run down unexpectedly.) This requires opening the incision to replace the generator. This procedure is shorter than the initial one. The same situation would occur if the leads needed to be replaced.

8. How will my biventricular pacemaker react in the outside world?
When you first get your biventricular pacemaker, you will be given an ID card to carry. This card contains important information about your biventricular pacemaker. Show it to any doctor, dentist or other medical professional you visit. Since all pacemakers also tend to set off security devices at airports and libraries, you'll need to show your card to security personnel.

Microwave ovens in good working order will not interfere with your biventricular pacemaker. Things like computers, hair dryers, power tools, radios, televisions, stereos, electric blankets, vacuum cleaners, heating pads and cars are all okay to use.

There are a few things that might interfere with your biventricular pacemaker. These include very strong magnets (like those used for MRI tests), heavy-duty electrical equipment, radio transmitting towers, ham radios, certain surgical instruments and cellular phones. (When using a cellular phone, use it on the ear farthest from your pacemaker. Don't carry the cell phone in your breast pocket either.) Do not linger between store anti-theft detectors. Walk quickly through them, as they also create a magnetic field. Avoid leaning directly over the open hood of a running car, as the engine generates an electrical field.

9. Will my insurance cover this?
Depending on the type of coverage, most commercial insurance carriers will pay the major share of the cost. You should always consult your insurance company to determine proper coverage.

10. Who should I contact with questions about this test?
Feel free to consult your doctor.

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