Cardiac Resynchronization Therapy (CRT) with a BiV device

What is CRT?
Cardiac Resynchronization Therapy (CRT) involves the implantation of a pacemaker that paces both right and left ventricles simultaneously. A patient with a weak heart that has been damaged by a heart attack or other causes frequently experience symptoms of fatigue, shortness of breath, fluid retention and arrhythmia's. Many of these symptoms are caused by the reduced pumping function of the heart. When the hearts chambers do not pump together, the pumping function is reduced. By using CRT, the hearts right and left ventricle work together to make the pump stronger. CRT improves heart function in 2/3rds of patients treated. Some patients feel better immediately but for others it may take several months. Many patients have better functional capacity, less symptoms and a better quality of life after receiving CRT. Patients will still need to continue all medications prescribed by their cardiologist. Cardiac resynchronization therapy can be combined with an implantable cardiac defibrillator for those patients at risk for sudden cardiac death.

Who Qualifies?
Patients with symptomatic heart failure (fatigue, shortness of breath, fluid retention), an Ejection Fraction (EF) of < 35%, QRS duration of >120ms and a normal heart rhythm.

Where Is The Biventricular device Implanted?
The device is implanted (depending on individual anatomy) either within the pectoral muscle or underneath the skin on the left or right side of the chest.

What Is The Necessary Follow-up Care For Biventricular Device (CRT)?
Follow-up care is a life-long commitment. The device clinic located in the hospital is where a clinician using a programmer will check your Biventricular Device. Remember these devices have been around for a long time and with proper care they can help you feel good for many years to come. The first follow up appointment occurs 2 weeks after implantation to assure the site is healing well and that the device is functioning properly. Then you will be scheduled for an Echocardiogram for fine- tuning of the device settings. After that, follow up with the device clinic occurs every three months. Your cardiologist also may check these devices during your routine visits.

What Are My Limitations After I Receive My Device?
The wound site is only to be cleansed with a washcloth and no showering or bathing for a period of two weeks. The adhesive strips at the incision area will come off by themselves.

Care must be taken in raising the arm that is on the same side as the device. Do not raise this arm any higher than the height of your outstretched arm. It is advisable that no driving be done for two weeks after implantation of the device. Further instructions will be given at the two-week follow-up appointment.

Will I be able to use my microwave oven?
Yes, you may use any of the electrical appliances in your home. These include electric shavers, sewing machines, and all of your kitchen appliances...even your microwave oven. However, make note that some old microwave ovens (20 years or older) have proven faulty and any current leaking from one of these older microwaves could cause temporary confusion to your pacemaker. Should you ever be around one of these antiques, walk away and stay 4-5 feet from the oven when it is in use. But today's microwave ovens are very safe and you do not have to be the least bit concerned about any interference from them.

I travel by air, what about airport security?
The metal casing of the device, which is stainless steel, and some of its components will trigger the security screening devices at airports. If this happens, simply show your pacemaker identification card to the security guard (the function of your pacemaker is NOT affected by these airport devices).

PLEASE NOTE: If you have an implanted ICD because of the internal components, the device will trigger airport security alarms. The use of strong magnets over the device may adversely affect its function and even render it non-operational. Not all ICDs will be affected by a magnet. Consult with your physician.

Will I be able to use my cellular phone?
Studies have determined that to avoid any potential interference, individuals using cellular phones are advised not to hold the phones directly over their pacemaker or defibrillator. When certain cellular telephones are held too close (within 6 inches or 15 centimeters) to some implanted medical devices, studies indicate that there may be some temporary effects. Potential effects are due to the radio frequency signal of the phone. Any effect would be temporary and simply moving the phone away will return the pacemaker or defibrillator to its previous state of operation. Because cellular phone technology continues to evolve, and because of the great variety of cellular phones, pacemakers, and defibrillators, an absolute recommendation cannot be made to cover every phone and every patient. Therefore, to ensure no adverse effects are encountered, the following standard use guidelines have been developed by the industry.

**Maintain a distance of 6 inches (15 centimeters) between a handheld personal cellular phone and the implanted device.

**Portable and mobile cellular phones generally are capable of transmitting higher power levels than hand-held personal phones and a larger separation is recommended for digital phones capable of transmitting power levels above three watts.

Will I be able to have a CAT Scan or MRI?
Yes, you can safely have a CAT Scan, however a MRI (Magnetic Resonance Imaging) is a different story.
Because of the potential for damage to the device and/or induction of life threatening arrhythmias, the use of MRI is contraindicated in Pacemaker and ICD patients.

Static magnetic, alternating magnetic and radio frequency (RF) fields produced by MRI may adversely affect the operation of ICDs and Pacemakers.