Cardiac resynchronization therapy (CRT) is a procedure to treat heart failure when the ventricles beat at different times, causing the heart to be unable to pump blood effectively.
CRT involves the placement of a specialized device called a biventricular pacemaker or cardiac resynchronization therapy device into the heart. The procedure aims to improve the coordination and efficiency of the heart’s pumping action.
This article discusses the purpose of CRT, what the procedure entails, what a person can expect during recovery, and the risks and benefits. It will also cover the cost of the procedure.
The main goals of CRT are:
- Cardiac synchronization: CRT aims to synchronize the contractions of the heart’s chambers (ventricles), particularly when there is delayed or abnormal electrical conduction. By delivering electrical impulses to specific areas of the heart through specialized pacing leads, CRT helps the ventricles contract in a coordinated manner, improving the overall pumping efficiency.
- Symptom management: CRT can alleviate the symptoms of heart failure, including shortness of breath, fatigue, exercise intolerance, and fluid retention. By enhancing the heart’s pumping function, CRT may allow individuals to engage in physical activities with less discomfort and improve their exercise tolerance.
- Quality of life enhancement: By reducing heart failure symptoms, improving cardiac function, and enhancing overall hemodynamics, CRT can significantly improve the quality of life for individuals with heart failure. It can enhance their ability to perform daily activities, improve sleep quality, and reduce the need for hospitalizations.
- Improved hemodynamics: By optimizing the coordination of the heart’s chambers, CRT helps
enhance hemodynamics , which refers to blood flow through the heart and blood vessels. This can result in increased cardiac output, improved blood flow to vital organs, and reduced symptoms of heart failure.
CRT is primarily for people with moderate-to-severe heart failure symptoms, specifically those with reduced left ventricular ejection fraction (LVEF).
LVEF refers to the percentage of blood each heartbeat pumps out of the left ventricle. Candidates for CRT generally have an LVEF of 35% or lower.
CRT
- those with mild heart failure symptoms
- those with diastolic heart failure
- those whose heart chambers are not out of sync
According to the Heart and Stroke Foundation of Canada, the procedure usually takes 2–5 hours, and there are two approaches a surgeon can take:
- Endocardial technique: A person will have a local anesthetic for this procedure. They may also receive a mild sedative to help them relax during the procedure. The surgeon will make a small incision, usually below the collarbone, to access the blood vessels in the chest. They will then thread thin, flexible wires called leads through the veins and position them in specific areas of the heart. The surgeon will then place a pulse generator in the chest.
- Epicardial procedure: A person will require general anesthesia for this procedure. The surgeon guides the leads into the heart chambers using a fluoroscopy machine. They will then insert a pulse generator in the lower abdomen.
Once the leads are in place, the surgeon will test the device to ensure proper functioning and make any necessary programming adjustments.
The doctor will close the incision site with stitches or surgical adhesive and apply a sterile dressing.
Before someone undergoes CRT, their doctor will evaluate their heart condition through various tests, such as an electrocardiogram (ECG), echocardiogram, and possibly a cardiac catheterization.
Once the individual and the doctor decide to proceed with CRT, the doctor will provide further instructions regarding pre-procedure preparations. This may include information on:
- the timing of fasting before the procedure, including when to stop eating food or drinking liquids
- adjustments to medications or supplements that can thin the blood, such as when to stop taking them
- guidance on the safe use of other prescription medications for heart or other conditions during the lead-up to the procedure
After CRT, doctors will typically keep someone in the hospital for 24 hours to 5 days for monitoring, depending on which implantation technique the surgeon used.
Recovering from CRT can include:
- Follow-up care: Doctors will provide instructions on caring for the incision site, such as keeping it clean and dry. People may need to restrict certain activities for a short period, as advised by their doctor.
- Medications: A doctor may prescribe medications to manage heart failure symptoms and improve heart function. It is important to take these medications as directed and keep up with any follow-up appointments.
- Device checks: The CRT device will need periodic checks to ensure it is working correctly. These checks may be remote or in-person at a clinic or hospital. The doctor will adjust the device’s settings to optimize its performance.
- Recovery timeline: Recovery time can vary depending on individual factors, but most people can resume their usual activities within a few days to weeks after CRT implantation. A person’s doctor will provide specific guidance based on their condition.
Various factors can influence the outlook for someone after CRT, with age and overall health playing significant roles in the outcome.
Research has shown that CRT can
CRT also has associations with improved survival rates in certain individuals with heart failure, particularly those with severe symptoms and reduced heart function. However, while CRT is an effective treatment option, about
As the procedure becomes more common, medical developments have allowed doctors to improve their techniques, suggesting that the outcomes will
The benefits and risks of CRT include:
Benefits
Some of the
- improved heart function
- symptom reduction
- improved exercise tolerance
- reduced risk of hospitalizations
- prolonged survival
Risks
Like any medical procedure, CRT has associated risks:
Some of the
- infection
- bleeding and bruising
- pneumothorax — when air is present outside of the lung, within the pleural cavity
- allergic reactions
Additionally, the leads used in CRT may develop complications, such as dislodgement, fracture, or malfunction. A person may require additional procedures to reposition or replace the leads if complications occur.
Coverage can vary depending on several factors, including the person’s insurance plan, their medical condition, and the criteria set by the insurance provider.
Many health insurance plans in the United States cover CRT, particularly when doctors consider it medically necessary and it meets the established criteria for coverage.
However, some insurance plans may require pre-authorization or documentation of medical necessity before approving coverage for CRT.
People should consult their insurance provider and review their policy to determine the coverage details and any potential out-of-pocket costs associated with CRT.
The Centers for Medicare and Medicaid Services will cover CRT. The following table outlines the cost of CRT based on Medicare’s National Averages from 2022:
| Ambulatory surgical centers | Hospital outpatient departments | |
|---|---|---|
| Total cost | $8,236 | $10,840 |
| Doctor fee | $512 | $512 |
| Facility fee | $7,724 | $10,328 |
| Medicare pays | $6,588 | $9,137 |
| Patient pays | $1,646 | $1,702 |
CRT is a well-established and effective therapy for eligible patients with heart failure.
It can lead to improved heart function, symptom reduction, enhanced quality of life, and potentially prolonged survival. However, it may not be suitable for some people.
Medicare and Medicaid should cover the cost of the procedure.