Cardiac Resynchronization Therapy (CRT) in Heart Failure

Heart failure is a condition where the heart cannot pump blood effectively enough to meet the body’s needs. This can lead to symptoms such as shortness of breath, swelling in the legs, and fatigue. Some patients also develop problems with the timing of how the heart’s chambers contract, which can make heart failure worse.

What is Cardiac Resynchronization Therapy (CRT)?

CRT, also called a biventricular pacemaker, is a special type of pacemaker used in certain people with heart failure. Unlike a regular pacemaker that usually has one or two wires, a CRT device uses three leads (wires):

• One in the right atrium (upper chamber)
• One in the right ventricle (lower chamber)
• One placed on the left ventricle (through a vein on the heart’s surface)

This setup helps the right and left sides of the heart beat together again, restoring a more natural pumping pattern.

Who Needs CRT?

CRT is not for every patient with heart failure. It is most often recommended for people who:

• Have moderate to severe heart failure symptoms (NYHA Class II, III, or IV) despite medications.
• Have a weakened heart muscle (left ventricular ejection fraction ≤ 35%).
• Show evidence of an electrical delay in the heart’s rhythm (often a wide QRS on ECG, such as left bundle branch block).
• Are already on optimal medical therapy (medications like beta-blockers, ACE inhibitors, ARNI, and diuretics).

Benefits of CRT

1. Improved Symptoms and Quality of Life

Many patients notice they can walk farther, breathe easier, and feel less tired. CRT reduces swelling and allows patients to be more active in daily life.

2. Better Heart Function

CRT helps the heart pump more efficiently. It can reduce the size of the enlarged heart and improve pumping strength over time.

3. Reduced Hospitalizations

Patients with CRT often have fewer emergency visits and hospital stays for worsening heart failure.

4. Longer Survival

Studies show that CRT not only improves how people feel, but also helps them live longer compared to medicine alone.

CRT Devices: Pacemaker vs. Defibrillator

Some CRT devices are combined with a defibrillator (CRT-D). This adds protection against dangerous heart rhythms (sudden cardiac arrest). The choice between CRT-P (pacemaker only) and CRT-D depends on the patient’s overall risk and the doctor’s recommendation.

Life with CRT

• The procedure is done under local anesthesia with sedation.
• Most patients go home within a day or two.
• Regular check-ups ensure the device is working properly.
• Batteries usually last 5–8 years and can be replaced.

Key Takeaway

Cardiac Resynchronization Therapy is a proven treatment for certain patients with heart failure. It improves symptoms, enhances quality of life, reduces hospitalizations, and increases survival. For patients who meet the criteria, CRT can be a life-changing therapy.