1 Cardiac Resynchrnizatin Therapy A Guide fr Patients and Families What is a cardiac resynchrnizatin therapy device? Cardiac resynchrnizatin therapy (CRT) is a small electrnic device used t treat heart failure. It delivers tiny amunts f electrical impulses t the heart causing bth ventricles t pump tgether in a crdinated way. There are 2 types f these devices: a CRT pacemaker (CRT-P) and a CRT defibrillatr (CRT-D). Bth can send an electrical impulse t yur heart, triggering a heartbeat when needed. A CRT-D can als deliver a life-saving shck t return the heart rhythm back t nrmal. The CRT device has tw parts: a generatr and pacing leads. 1. The generatr is a small cmputer that mnitrs yur heart rate and rhythm. When needed, it sends either an electrical impulse r an electrical shck t yur heart. It is pwered by a specially designed battery. 2. The pacing leads (yu culd have 1 r mre) are insulated wires. One end cnnects t the generatr. The ther end attaches t the inside f yur heart. The electrical impulse r shck travels frm the generatr dwn the lead. What s inside? Why d I need a CRT?... 2 Are there any risks?... 3 What can I expect befre and after?... 3 When shuld I get help?... 4 Living with a CRT Device... 6 Frequently asked questins 10 Helpful resurces..12 CSBC CRT Patient Resurce July 2018 1
Why d I need a CRT? Yur heart has special cells that make up an electrical system. Electrical impulses trigger yur heart muscle t squeeze, and pump bld and xygen t yur bdy. Nrmally, the lwer chambers f the heart (ventricles) pump at the same time (synchrnized). Smetimes this electrical system is damaged by aging r heart disease. The damage can result in: Weakened heart muscle A heart rate that is either t slw (bradycardia) r t fast (tachycardia) When the heart muscle is weakened, less bld is pumped with each heartbeat and the lwer chambers d nt pump at the same time. This affects yur bdy s need fr bld and xygen. If yu heart beats t slwly and the lwer chambers are nt pumping at the same time, a CRT pacemaker (CRT-P) can send electrical impulses t trigger yur heart t beat as well as help bth lwer chambers t pump at the same time (called resynchrnizatin). When the heart beats t fast, the heart cannt pump enugh bld and xygen t the bdy. If this is nt treated quickly, the heart can stp (called cardiac arrest) and death fllws. When there is a chance f the heart stpping frm a dangerusly fast heartbeat, a CRT defibrillatr (CRT-D) can help in 3 ways. It can send an electrical impulse t trigger yur heart t beat, help bth lwer chambers t pump at the same time, and/r send an electrical shck t the heart t stp the dangerusly fast heartbeat. A CRT device is an ptin fr peple wh have: Mderate t severe heart failure An existing heart rate prblem (r a greater chance f having a heart rate prblem) such as a heart rate that is t slw r dangerusly fast CSBC CRT Patient Resurce July 2018 2
Are there any risks? The prcedure t insert a CRT is called implantatin. A CRT implant is a cnsidered a rutine, minr surgical prcedure with little chance r risk f prblems. Bruising arund the implant site is cmmn. Hwever, as with any medical prcedure, prblems are pssible. Althugh rare, these prblems are imprtant t knw (listed here frm mst likely t least likely): Prblem Chance f it happening Hw it is treated Pacing lead becmes disldged Bleeding arund the CRT site (hematma) Cllapsed lung (pneumthrax) Infectin Cllectin f bld arund the heart (cardiac tampnade) 3 t 6% chance (30 t 60 peple in 1000) 1 t 2 % chance (10 t 20 peple in 1000) 1 t 2 % chance 1 t 2 % chance 0.1 % (1 persn in 1000) Anther prcedure wuld be needed t put the lead back int psitin. Smetimes the bleeding arund the CRT is large enugh that the bld needs t be drained ff. Chest x-ray is dne after the prcedure t check fr this. Often, it des nt need t be treated, but it might need a drain int the chest t help the lung return t nrmal. T prevent an infectin, everyne is given antibitics befre the prcedure. They may be required after the prcedure if an infectin ccurs. Chest x-ray is dne after the prcedure t check fr this. Often, it des nt need t be treated, but it might need t be drained. It is imprtant t ask yur dctr abut the risks f a CRT implant in yur specific situatin. CSBC CRT Patient Resurce July 2018 3
What can I expect befre and after? Hw t prepare fr the prcedure Always bring yur BC Services Card (r Care Card) plus a list f the medicatins yu are currently taking t every appintment and the day f yur prcedure. Since yu cannt drive hme after yur prcedure, arrange fr smene t drive yu t the hspital and hme again. Yu als need t arrange fr smene t stay with yu at hme fr the first 24 hurs after the prcedure. Yu will get mre specific instructins frm the hspital r ffice f the dctr ding the prcedure. Yu will be instructed as t hw t take yur medicatins befre the prcedure. Certain medicatins (like bld thinners and diabetic pills) might need be adjusted. It is imprtant t review these instructins carefully and take medicatins as directed. Talk with yur dctr abut future driving restrictins. The B.C. Mtr Vehicle Act has strict rules n when peple are allwed t drive after having a CRT implanted. A week r s befre the prcedure, yu might be asked t g fr sme bld wrk and an electrcardigram (E.C.G.), and an echcardigram. D nt eat r drink anything the mrning f yur prcedure, unless yu have been specifically tld smething different by the hspital r yur dctr. Befre the prcedure Yu are admitted and directed t the prcedure waiting area. If yu are already a patient in hspital, yur healthcare team will help yu get ready fr the prcedure. An intravenus (I.V.) is started in ne f yur arms t give yu medicines during the prcedure. Yu have bldwrk drawn and an electrcardigram (ECG). The dctr reviews the prcedure and then yu will be asked t sign a cnsent frm. CSBC CRT Patient Resurce July 2018 4
During the prcedure Mst peple are awake fr the prcedure. Yu are given a medicine t help yu relax and feel cmfrtable. The dctr injects a numbing medicine under the skin t freeze the area where the CRT is being implanted. A small cut r incisin is made n the right r left side f the upper chest just belw yur cllarbne. Yur dctr talks with yu befrehand abut which side is best fr yu. The dctr uses a special x-ray t guide the pacing lead(s) thrugh a large vein and int yur heart. Once the leads are attached (implanted) in the inside f the heart, they are tested t make sure they are wrking crrectly. The CRT generatr is then placed in a space under the skin. The incisin is stitched clse with stitches that will disslve n their wn ver time. The prcedure takes abut 1 t 2 hurs. After the prcedure Yu are mved t a recvery area. The nurses there mnitr yur heart rhythm and bld pressure. Yu might feel sme discmfrt arund the incisin and yu might have a sre shulder. Let the nurses knw if yu are having any pain s they give yu medicine t relieve it. The nurses will let yu knw when it is safe fr yu t eat and drink. Yu might g hme frm this area r yu might be mved t anther unit if yu need t stay in the hspital lnger. Ging Hme Hw sn yu g hme depends n yur medical cnditin and recvery frm the prcedure. Sme peple g hme the same day. Others need t stay in the hspital fr a few days. CSBC CRT Patient Resurce July 2018 5
Befre yu leave hspital, yu are given instructins fr hw t care fr yurself at hme. The nurse reviews this infrmatin with yu, such as: Caring fr yurself at hme Driving restrictins Caring fr yur incisin Restrictins t arm mvements Managing pain CRT clinic fllw-up appintments When t take medicatins When t get help Nte: The persn staying with yu fr the first 24 hurs shuld be there t hear these instructins. When t get help Cntact yur family dctr right away if yu ntice any f the fllwing: Any redness, swelling, r clured liquid cming frm yur incisin A fever ver 38.5 C (101.3 F) New bruising r redness arund the incisin Pain that gets wrse r des nt imprve with pain medicine Call 9-1-1 if yu ntice any f the fllwing: A shck frm yur CRT-D and yu d nt feel well afterwards Truble breathing r cannt catch yur breath Really bad chest discmfrt r pain Feeling really dizzy r cnfused Heart feels like it is racing r beating really fast 2 r mre shcks within 24 hurs Living with a CRT device Mst peple wh receive a CRT can return t their nrmal activities f daily living. Belw are tips t help yu stay healthy. Attend fllw-up appintments Every persn with a CRT needs t be checked regularly by a CRT clinic. These checks are bth in the clinic and remtely frm yur hme. CSBC CRT Patient Resurce July 2018 6
Remte mnitring is a way fr yur CRT t send infrmatin abut yur heart activity wirelessly frm hme. Yur infrmatin is sent thrugh a secure cnnectin t a secure website. If this is an ptin fr yu, the CRT team will yu help yu t get started. Befre yu leave the hspital, speak t yur nurse r dctr abut the CRT clinic clsest t yur hme. Yur first appintment will be within 2 t 4 weeks. After this, yur CRT must be checked in the clinic at least nce every year. Let yur clinic knw f any changes in yur address r phne number. During visits t the clinic, the dctr and clinic staff: Check yur CRT battery and leads. Review yur CRT settings t make sure it is prgrammed t best meet yur needs. Adjust the CRT settings as needed. Prtect yur pacing leads The mvement f yur arm n the same side as yur CRT may be limited fr a perid f time after the prcedure. The instructins frm the hspital will include what yu can and cannt d. Fr at least 6 weeks after the prcedure, yu are nt allwed t d any strenuus shulder activities like glfing, swimming, tennis, shvelling, raking, r vacuuming. These restrictins prevent the pacing leads frm being disldged. Prtect yur CRT generatr D nt place magnets near yur CRT. Keep magnets at least 6 inches frm the generatr. Never put a cell phne in a pcket ver yur CRT. Walk thrugh anti-theft detectrs at a nrmal pace withut any delay. D nt remain in r near the system fr any length f time. They have electrmagnetic fields and can temprarily affect yur CRT. CSBC CRT Patient Resurce July 2018 7
Keep the generatr away frm these items: At least 6 inches (15 cm) away - hand held electric kitchen appliances (e.g. mixers and knives), electric tthbrush charging bases, electric shavers, exercise bikes and treadmills, hand held hair dryers, stere speakers, vacuums, sewing machines, and radi-cntrlled items (including the antenna). At least 12 inches r 1 ft (30 cm) away - electric fences, vehicle ignitin systems, green electrical transfrmer bxes fund utside, car battery chargers, generatrs 20 kw r less, uninterrupted pwer surces (UPS), and gasline pwered tls (e.g. chainsaws, lawn mwers, weed trimmers, and snw blwers). At least 24 inches r 2 feet (60 cm) away - inductin ck tps, jumper cables, bench munted r free-standing pwer tls with 400hp mtrs r less (e.g. air cmpressrs, drill presses, grinders, pressure washers, table saws, and welding equipment with currents under 160 amps). D nt use: TENS machines, magnetic mattresses r pillws, muscle stimulatrs. Stay away frm large magnets such as the nes fund n cranes r in junkyards t lift cars. If yu wrk in any high vltage areas, talk t yur dctr r CRT clinic. High vltage is fund arund things like arc welders, smelting furnaces, radi and televisin twers, and hydr and radi statins. Knw yur shck plan If yu have a CRT defibrillatr, review yur shck plan regularly with the CRT clinic. Shcks can be startling and painful, but they are nt necessarily a sign f truble. It is cmmn t feel anxius that yu might get a shck at any time. Talk with the CRT clinic staff abut yur wrries and cncerns. If yu get 1 single shck and yu feel fine fllwing, write dwn the time yu gt the shck and call yur CRT clinic as sn as pssible. CSBC CRT Patient Resurce July 2018 8
Call 9-1-1 if: Yu get 1 shck and d nt feel well fllwing. Yu get 2 r mre shck within 24 hurs. D nt drive until yu are tld it is safe t return t driving. Tell thers yu have a CRT At the hspital, yu are given a temprary CRT identificatin card describing what type f CRT yu have. Always carry yur CRT Identificatin card with yu. The cmpany that made yur CRT will mail yu a permanent CRT Identificatin card 4 t 8 weeks after yur prcedure. Always tell yur dentist, physitherapist, massage therapist, and chirpractr yu have a CRT. They might need t take special precautins befre starting certain medical prcedures r therapies. Take yur medicatins Make a list yur medicatins, the dsage, and the times yu take them. Always bring this list t all yur CRT fllw-up appintments. Remember t update yur list when they change. Take them exactly as instructed. Stay active Mst peple return t their usual daily activities, nce they have recvered. Include physical and mental activity int yur daily schedule. Each persn is unique. Talk t yur dctr abut the kind f activities and exercises that are best fr yu. Start slwly and gradually increase. Fr mst peple, it is safe t resume sexual activity after a CRT implant, hwever try nt t supprt yur weight with yur arms during sexual activity while yur incisin is healing. N harm will cme t yur partner shuld yur CRT give yu a shck, even if yu get the shck during intercurse. CSBC CRT Patient Resurce July 2018 9
Ask questins Call yur heart dctr r family dctr. Call yur CRT Clinic. Call HealthLink BC at 8-1-1 any time f the day r night t speak t a registered nurse. During the night, yu can ask t speak t a pharmacist. CRT cmpanies ffer nline supprt fr nn-urgent questins r cncerns. Their cntact infrmatin is available nline r in yur pacemaker infrmatin bklet. Frequently Asked Questins When can I drive? The B.C. Mtr Vehicle Act says that after a CRT implant: Yu must have yur dctr s apprval befre yu can drive again. Yu are nt allwed t drive a private vehicle (class 5 license) until yur dctr says it is safe t drive. This culd be anywhere between 4 weeks t 6 mnths. Yu are n lnger allwed t drive a cmmercial vehicle (class 1 t 4 license) at any time. What is electrmagnetic interference (EMI)? Any items that generate, transmit, r use electricity have invisible electrmagnetic fields arund them. This electrmagnetic field might affect the nrmal peratin f yur CRT. This is called electrmagnetic interference (EMI). Mst husehld items are safe t be near and use, including items such as: battery chargers, curling irns, hair straighteners, electric blankets, guitars r tthbrushes, massage chairs, heating pads, ht tubs, saunas, tanning beds, electrnic weight scales, and kitchen appliances including micrwave vens. It is als safe t be near and use electrnics such as TV s, radis, cmputers, tablets, MP3 players, fax machines, phtcpiers, DVD and CD players with remte cntrl, printers, and GPS devices. CSBC CRT Patient Resurce July 2018 10
What d I d if I think an item is causing EMI? If yu feel dizzy using an electrical item, put it dwn and mve away frm it. Yur CRT shuld return t nrmal. If yu cntinue t feel dizzy r feel wrse, cntact yur CRT clinic r dctr right away. Can I travel with a CRT? It is safe t travel with a CRT. Let the CRT clinic knw if yu are planning t travel. Ask hw t get help medical help if needed and hw t set up yur remte transmitter while yu are away. Tell airprt security persnnel yu have a CRT and shw yur ID card. It is safe t pass thrugh the airprt metal detectr, have a bdy scan and have a hand-held metal detectr used n yu. Hw lng will my CRT last? The CRT battery will need replacing ver time. This minr prcedure is called a generatr (battery) change. Yur CRT clinic will rganize a replacement when needed. The battery generally lasts 5 t 8 years but will depend n hw much yur bdy needs the CRT t pace yur heart. If yur pacing leads are wrking well, they are left in place. CRTs d nt stp withut warning. Even as the battery weakens, yur CRT cntinues t wrk as it shuld. What happens t my CRT at end f life? CRT pacemakers d nt keep dying peple alive. Shuld yur health decline t the pint where death is likely, yur CRT pacemaker will nt prevent a natural death. If yu have a CRT defibrillatr, there culd cme a time when yu wuld prefer NOT t have yur death prevented by a shck frm yur CRT. Yu might wish t have the shck functin turned ff r deactivated. Yur CRT will still wrk as a pacemaker fr slwer heart beats. If yur heart beats dangerusly fast, the CRT wuld nt shck yu, allwing yu t die naturally. Talk t yur family and yur dctr abut turning ff the shck functin. Make sure everyne understands yur wishes. If yu are thinking f getting the shck functin turned ff (deactivating), yur dctr will help yu with the steps. CSBC CRT Patient Resurce July 2018 11
Fr Mre Infrmatin This bklet explains basic infrmatin abut living with a CRT. Fr mre detailed infrmatin abut getting a CRT, read the infrmatin given t yu by yur dctr s ffice r hspital befre the prcedure. Fr mre detailed infrmatin abut yur specific CRT, read the bklet frm the cmpany that made the CRT, r visit their website. If yu have questins that are nt addressed in this bklet, ask yur dctr r clinic. Helpful Resurces Cardiac Services BC BC Heart Failure Heart and Strke Fundatin f Canada Canadian Heart Rhythm Sciety Heart Rhythm Sciety HealthLinkBC Phne: 8-1-1 Phne: 7-1-1 fr deaf r hard f hearing www.cardiac.bc.ca www.bcheartfailure.ca www.heartandstrke.ca www.chrsnline.ca www.hrsnline.rg www.healthlinkbc.ca Medtrnic Device Cmpany Website www.medtrnic.cm Abbtt / St. Jude Medical www.sjm.cm Bstn Scientific www.bstnscientific.cm Bitrnik www.bitrnik.cm Srin www.livanva.srin.cm CSBC CRT Patient Resurce July 2018 12
July 2018