The heart contains two lower chambers called ventricles. The left ventricle pumps blood around the body while the right is responsible for pumping blood to the lungs. In a normal heart, both ventricles work in tandem, regulating the amount of blood that’s being pumped within your body. With heart failure, one of the ventricles falls out of sync with the other, meaning the heart can no longer pump enough blood. Heart failure can cause a number of symptoms, including shortness of breath, dizziness, nausea, fatigue and an irregular heartbeat. Over time, it can cause the heart to become weaker. In serious cases, it can lead to kidney or liver damage and sudden cardiac arrest.
A pacemaker is a small, battery-powered device that monitors the heart for rhythm problems (arrhythmia) and prevents the heart going too slow. If it detects that the heart is slow, it can deliver a tiny electrical pulse that stimulates the heart into correcting its abnormal rate. The device sits just below the skin of the chest or abdomen, or directly inside the heart, connected either directly or through one or more wires (also known as “leads”). There are several different types of pacemakers, one of which is specifically designed for people with heart failure. This is known as a Cardiac resynchronisation therapy (CRT) pacemaker.
CRT pacemakers are very similar to standard pacemakers. They monitor your heart for rhythm problems and can generate electrical signals that stimulate the ventricles into contracting normally, to restore natural rhythm. The aim is to relieve your symptoms and protect your heart from further damage. The main difference with a CRT pacemaker is that it usually has an extra lead to the left ventricle. It will deliver a pulse of electricity that forces the ventricles to “resynchronise” and start working together again. We call this “biventricular pacing”. Some CRT devices also come with an additional defibrillator element called an implantable cardioverter defibrillator (ICD). These are known as CRT-D devices. They are often recommended for patients who have had, or are at risk of suffering, a serious heart rhythm problem like ventricular tachycardia (VT) or ventricular fibrillation (VF).
CRT pacemakers are fitted using “transvenous implantation”, which means the leads will be inserted through one of your veins. We make a small incision (about 5cm wide) underneath your collarbone, usually on the left-hand side of your chest. We then use an x-ray imager to help guide the leads down the vein to your heart. Once in place, the leads are connected to your pacemaker device, which will be carefully situated underneath your skin. We’ll test the device to make sure it’s working properly. CRT pacemaker fittings are usually done with a local anaesthetic. We may also offer you a sedative to help you relax and feel comfortable during the procedure.
When you arrive at the clinic, the medical team will assess you and run through your details. You’ll then be taken through to the theatre, where we’ll give you a sedative to help you feel relaxed (or a general anaesthetic, if you’re having one). Before the procedure begins, we carefully prepare the area around the incision with an antiseptic solution to keep everything as clean as possible. We then insert the leads and connect them to your pacemaker device, which will sit within a tiny pocket underneath the skin. Before completing the procedure, we test your device to make sure it’s functioning well. Finally, we close the wound with medical dissolvable stitches. The whole procedure usually takes around 90 minutes from beginning to end.
When your operation has finished, the team will take you back to the ward to rest for an hour or two. We may also run some tests – such as an ECG – to check on your heart rhythm. The incision area will feel quite bruised for the next few days, so we’ll give you some painkillers to take. We may also give you some antibiotics to reduce the chance of infection. You can shower but otherwise you’ll need to keep the wound clean and dry until it has healed completely. We will see you again after approximately six weeks to check that your pacemaker is still working well.
There are several other things you should know if you’re set to have a CRT pacemaker, or thinking about having the device. One is that you will receive an ID card with your device, before you leave the hospital – these are issued for all pacemakers, and you’ll need to carry yours with you at all times. ID cards detail the make and model of your device; this gives doctors essential information about your pacemaker if you need treatment in the future. In some patients, heart failure pacemakers also have implications for things like car insurance, future operations, and for use with certain household devices, such as mobile phones and magnetic equipment. For more detail, see the Pacemakers section (scroll to What else do I need to be aware of?). (For more about driving, see Will I be able to drive after my pacemaker fitting?) We’ll also give you comprehensive information about how to look after your heart failure pacemaker before you leave the hospital.
Yes. Besides your follow-up appointment (usually around six weeks after the fitting), you will need to come into the clinic for regular pacemaker checks. These usually need to happen once a year, but could potentially be more frequent than that. These checks allow us to review your heart failure pacemaker’s settings and battery life, and test the condition of the leads. We can make adjustments if we need to. We will also monitor your heart rhythm and save all the data from your tests to your medical records.
All batteries run out eventually, but we’ll make sure you have plenty of notice before this happens to your device. The battery life for most heart failure pacemakers is at least six years, and in some cases up to 12. We’ll test your battery when you come in for a check-up so we know how much power it has left. To change the battery on your device, you’ll need to come into clinic for a new fitting. This procedure is similar to the initial fitting, but generally much quicker because in most cases we won’t be inserting new leads into your heart.