WHAT WE DO

Device Implantation

CRTs (Cardiac Resynchronization Therapy)

Definition:

CRTs are specialized pacemakers used to treat heart failure by coordinating the contractions of the heart's ventricles. Also known as biventricular pacemakers, they send electrical impulses to both the right and left ventricles to improve the timing of their contractions.

Key Features:

  • Helps improve cardiac output in patients with dyssynchronous ventricular contractions.
  • Often used in patients with a wide QRS complex and reduced ejection fraction.
  • Can be combined with a defibrillator (CRT-D) for added protection against life-threatening arrhythmias.

CSP (Conduction System Pacing)

Definition:

CSP is an advanced pacing technique that targets the heart’s natural conduction system, such as the His bundle or left bundle branch, to achieve more physiological activation of the ventricles.

Key Features:

  • Aims to preserve natural ventricular contraction patterns.
  • Often considered an alternative to traditional right ventricular pacing or CRT, especially in patients with heart block or heart failure.
  • Includes His bundle pacing (HBP) and left bundle branch area pacing (LBBAP).

ICDs (Implantable Cardioverter-Defibrillators)

Definition:

ICDs are implantable devices that monitor heart rhythms and deliver electric shocks if a life-threatening arrhythmia like ventricular tachycardia or ventricular fibrillation is detected.

Key Features:

  • Primarily used to prevent sudden cardiac death in patients at high risk.
  • Some ICDs also have pacemaker functions to treat bradycardia.
  • Can be transvenous (implanted with leads in the heart) or subcutaneous (leadless systems placed under the skin).

Cardiac Resynchronization Therapy

Cardiac Resynchronization Therapy (CRT) is a type of pacemaker-based therapy used to improve the coordination of heart contractions in patients with heart failure and electrical conduction delays. It involves implanting a specialized biventricular pacemaker (CRT-P) or a defibrillator (CRT-D) to synchronize the contractions of the left and right ventricles, improving heart function.

A CRT device has three leads:

  1. Right atrial lead (optional, for atrial sensing in patients with sinus rhythm).
  2. Right ventricular (RV) lead (for standard pacing).
  3. Left ventricular (LV) lead (placed via the coronary sinus to pace the LV).

The device stimulates both ventricles simultaneously, correcting dyssynchrony caused by conduction delays (e.g., Left Bundle Branch Block, LBBB).

Types of CRT Devices

  1. CRT-P (CRT Pacemaker) → For pacing only.
  2. CRT-D (CRT with Defibrillator) → Combines pacing with an implantable cardioverter-defibrillator (ICD) for patients at risk of sudden cardiac death (SCD).

Who Needs CRT?

  • Heart failure patients (HFrEF ≤ 35%) who remain symptomatic despite medications.
  • Patients with a wide QRS complex (≥120–150 ms), especially those with LBBB.
  • NYHA Class II-IV symptoms (moderate-to-severe heart failure).
  • Patients needing frequent right ventricular pacing to prevent pacing-induced cardiomyopathy.

Benefits of CRT

  • Improves heart function and ejection fraction (EF)
  • Reduces heart failure symptoms (fatigue, dyspnea, edema, exercise intolerance)
  • Lowers hospitalization and mortality rates
  • Enhances quality of life

Pacemaker After Care

After a few weeks since insertion of the pacemaker, extra tissue will start to develop around the leads in your heart, helping to secure them in place and prevent any movement.

  • For the first 14 days, avoid lifting the arm on the side of the pacemaker above shoulder level, stretching it behind your back, or engaging in heavy lifting.
  • However, it's important to gently move your arm and shoulder forward and backward to keep the muscles active and prevent a frozen shoulder.
  • Once you've had your first pacemaker wound check-up, your doctor or technologist will evaluate the device. If there are no complications, you'll be cleared to return to your normal activities.
  • Keep your dressing on for 7–10 days.
  • If your dressing comes off before the 7–10 days have passed, please contact the practice and report to the sister.
  • A wound check will be booked 10 days after the procedure, and only then should the dressing be removed by the sister.
  • Once the dressing is removed, wash the area with warm water and soap.
  • Do not use any ointments or dressings.
  • Keep the wound clean and dry.

Your wound site should take about six weeks to fully heal. Try to avoid wearing tight clothing over the wound until it has completely healed to prevent excessive rubbing in the area.

Be cautious of:

If you notice any redness, soreness, swelling, or signs of bleeding or oozing from the wound, contact your GP or Cardiologist’s practice immediately, as these could be signs of infection.

You may be able to feel the pacemaker box under your skin, as well as other lumps nearby. These lumps are the leads attached to the box, curled up beside it under the skin. It’s very important not to try and move the box or leads under the skin. However, if they continue to cause discomfort, contact your cardiologist’s practice immediately.

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Tests and Procedures

Checkmark IconECG Checkmark IconHolter ECG Checkmark IconImplantable Cardiac Devices (Pacemakers, Defibrillators, Loop Recorders)
Checkmark IconInvasive Electrophysiology (EP) Study Checkmark IconCatheter Ablation for: SVT, VT/PVC, Atrial Fibrillation (Radiofrequency, Cryoablation, Pulsed Field) and Flutter

What We Do

Checkmark IconCardiac Electrophysiology Checkmark IconManagement of Tachycardia Checkmark IconAtrial Fibrillation (AF) Care Checkmark IconAtrial Flutter (AFL) Treatment Checkmark IconVentricular Arrhythmias
Checkmark IconSupraventricular Arrhythmias Checkmark IconElectrophysiological Studies (EP Studies) and Ablation Checkmark IconDevice Implantation Checkmark IconConduction System Pacing
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