Medical Rounds with Dr. Steven Zweibel

Cardiac Resynchronization Therapy (CRT) has been shown to improve the overall quality of life in patients with congestive heart failure. Dr. Steven Zweibel is the Director of Electrophysiology at Hartford Hospital and explains more about how CRT works.



Q. WHAT IS CRT?
A. CRT stands for cardiac resynchronization therapy. This is a therapy for patients who have continued symptoms from congestive heart failure despite the use of medications. CRT is achieved by pacing both lower chambers of the heart (the ventricles) at the same time and has been shown to improve a patient’s quality of life, reduce hospitalizations for heart failure, and even improve the pumping function of their heart. CRT can be used with either a pacemaker or along with an implantable cardioverter defibrillator (ICD).

Q. WHICH PATIENTS MAY BE CANDIDATE FOR THIS THERAPY?
A.
Patients who most benefit from CRT are those who have a weak heart (a cardiomyopathy) along with symptoms of congestive heart failure despite being on a good medical regimen, and evidence that their ventricles are not beating together (synchronously). This evidence usually comes from a finding on an electrocardiogram (EKG) called a left bundle branch block. In a left bundle branch block the electrical signal travelling from the upper to the lower chambers of the heart goes through the right bundle branch – thereby forcing the right ventricle to beat before the left ventricle. CRT enables us to force both ventricles to beat at the same time again.

Q. WHAT DOES THE PROCEDURE ENTAIL? HOW DOES IT WORK?
A. To provide CRT to a patient, we need to implant either a pacemaker, or more often, an ICD. This involves making a small incision in the patient’s upper chest – near the shoulder – and threading wires (or leads) through veins into the heart. We typically place leads in the upper right chamber (the right atrium) and the lower right chamber (the right ventricle) like we would normally do for a routine pacemaker or ICD. We then use a special set of tools to thread another lead into a branch of a vein that sits on the outside of the left ventricle. All of these leads get hooked up into the device which is then placed under the skin in the chest. The device is then able to coordinate the beating between the upper and lower chambers of the heart and is also able to force the two lower chambers of the heart to beat together (resynchronization).

Q. WHAT IS THE RECOVERY/FOLLOW-UP CARE?
A.
These procedures usually take 2-3 hours to perform. Patients typically stay overnight one night and are sent home the next morning. Depending on the type of anesthesia used, recovery is usually fairly rapid and patients are back to their daily activities within a week or two. All patients are provided with a remote monitor which they keep plugged in at their bedside. This enables us to keep track of their device and immediately notifies us if there are any issues that could require immediate attention. We see the patients back in the office within a few weeks to make sure the wound is healing appropriately and that the device is functioning as expected. Afterwards we will follow-up their devices remotely every few months and see them in the office once or twice a year. Patients also follow-up with their PCPs and cardiologists to make sure they are continuing on an appropriate medical regimen.


For more information

For more information please call: 860.972.1506

Website: https://hartfordhospital.org/services/cardiology-heart-care/conditions-treatments/cardiac-electrophysiology


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