1. What do CRTP and CRTD stand for?

CRT stands for cardiac resynchronization therapy. The suffix P refers to pacing while D refers to defibrillation. A CRT device that also has the function of an ICD is called CRTD.

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2. What is the difference between a CRTP and a CRTD?

A CRTP is a machine that helps improve the pumping of the heart. The CRTP helps do this by making all parts of the heart contract simultaneously. A CRTD machine is a device that has both the functions of a CRTP, and an ICD put together.

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3. What is the benefit I will get by having a CRTP implanted?

A CRTP helps improve heart pumping. This will reduce the patient’s symptoms of breathlessness, tiredness, and lack of energy.

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4. What is the cost of a CRTP or CRTD?

The cost of a CRTP/CRTD depends on the model used.

The cost of a CRTP can range from Rs. 2,50,000 to Rs. 4,00,000 approximately. The cost of the entire package including getting admitted, having the CRTP fixed, bed charges, nursing care and doctor’s fees will cost you approximately Rs 3,00,000 to Rs 4,80,000 all-inclusive depending on the device you choose.

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The cost of a CRTD can range from Rs. 4,60,000 to Rs.7,00,000 approximately. The cost of the entire package including getting admitted, having the CRTP fixed, bed charges, nursing care and doctor’s fees will cost you approximately Rs 5,40,000 to Rs 7,80,000 all-inclusive depending on the device you choose.

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5. How long will I need to stay in Vellore to get the CRTP/CRTD done?

Once you have the date of the procedure fixed, you will need to plan for a 4 day stay in Vellore which will include a 3-day hospital stay to get the CRTD/CRTP done.

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6. What are the types of CRT?

CRT can either be a CRTP or a CRTD. A CRTD is a CRTP with an ICD function added. They can be MRI compatible or not. The CRT device can use a bipolar or a quadripolar lead for the left ventricle. The details of their functions will be explained to you by a doctor.

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7. Is a bipolar CRTP better than a quadripolar CRTP?

A CRTP is being put to improve cardiac pumping. It does this by trying to make all parts of the heart contract together. A bipolar lead has 2 poles to capture the heart muscle as against a quadripolar lead which has 4 poles. By having more poles, the quadripolar lead has a higher probability to capture all the relevant areas. Hence, the chance of success in terms of recruiting all the relevant heart muscle is more likely with a quadripolar lead.

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8. Can the CRT also work as a pacemaker?

Yes, a CRT can also work as a pacemaker if necessary, though the vice versa is not true.

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9. Would it hurt me when I undergo the procedure of having a CRTP/CRTD implanted?

No, it will not hurt you as the procedure will be done under local anesthesia. It will only hurt as much as a mosquito bite, the moment when the local anesthesia injection is given. After that injection is given, the medicine will act, and you will not have any pain.

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10. How long will the procedure take?

The procedure will take around 3 to 4 hours which includes a great deal of time that is devoted to doing it in a sterile fashion so as to minimize the risk of infection.

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11. Who will do my procedure?

Your procedure will be done by one of the six consultants in the Cardiac Electrophysiology Unit. They include Dr. David Chase, Dr. John Roshan, Dr. Sirish Chandra Srinath, Dr. Anand, Dr. Hariharan and Dr. Javaid. All of them have vast experience in doing these procedures. If you have been a private patient of one of them then the particular doctor you saw will do your procedure. In case your doctor is unwell and not available, your procedure will be done by one of the other five so as to not keep you waiting.

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12. Will I be awake during the procedure?

You will be awake for the procedure and can have a chat with your doctor as he does it. However, you may feel sleepy due to the medicines given and you are welcome to take a nap if you feel inclined to doing so. We will wake you up after it is over.

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13. Will my heart pumping definitely improve after the CRTP? How long does it usually take for me to feel better?

There is a 60-70% chance that your heart pumping will improve after a CRTP. The reasons why everyone does not improve is not fully clear. A lot of the improvement depends on the ability to place the leads such that they get all parts of the heart to contract together. However, the patient’s anatomy may be such that it is not possible to place the lead in the ideal position owing to small or absent veins. This may limit the success of the procedure. Sometimes patients come in an advanced stage of the disease when the loss of pumping is irreversible, making improvement less likely. The medicines that you take can also help improve your heart pumping and make you feel better. It usually takes about 3-6 months to get the benefit from CRT and start feeling better. Some patients however start feeling well soon after the procedure.

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14. By how much will my heart pumping improve?

The amount of improvement in heart-pumping varies from patient to patient and depends on various factors like the site where the lead was placed and the amount of irreversible disease in the heart. How the patient feels over the months after the CRT is implanted is more important than the actual heart pumping value as determined by the ECHO. Some patients, about 10-15%, called super responders become totally normal after the CRT. The vast majority of patients have at least a 5% increase in their heart pumping.

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15. Will I be able to do all activities after the CRT like a normal person?

The level of improvement in symptoms provided by CRT makes a huge impact on the individual’s quality of life. The amount of physical activities you can do usually correlates with how much your heart pumping has improved. Usually one is able to do a bit more than what he was doing earlier. For example, someone who was breathless while taking a bath will no longer have breathlessness on doing so, though he is likely to be breathless on climbing a flight of stairs.

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16. How long does the battery last? Does it need to be changed?

The CRT battery life is usually around 8 years. However, the battery life varies depending on individual use. It gets over early if it is used a lot due to the individual’s heart needing more current from the battery to make it contract.

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17. What are the possible complications? 

The chance of having a complication during or after a CRT procedure is very rare; less than 1 in 100 chance. The complications can include swelling in the operation area due to bleeding or a tear in the heart due to the CRT leads causing a perforation. The most important and dreaded complication is an infection. We take a lot of pains in ensuring that there is strict asepsis maintained during the procedure. It is important for patients particularly those with diabetes to get their dental, skin, or urinary infections promptly treated. If an infection in any part of the body is neglected it will spread to the CRT device. The other potential complications are being a nonresponder and phrenic nerve capture.

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18. Who is a nonresponder? 

The CRT is meant to improve heart function and make the patient feel better. However, there is a small subset of patients who do not have any improvement whatsoever. This may be due to various reasons some of which can be corrected. It is important for your doctor to look for correctable reasons at the time of your follow up and address them accordingly.

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19. What is phrenic nerve capture? What does it lead to?

The phrenic nerve is the nerve that supplies a muscle called the diaphragm. Sometimes one of the 3 CRT leads/wires can cause stimulation of this muscle. This will lead to hiccoughs. If this happens the patient needs to come and meet his doctor who will help change the device programming and settings so as to overcome this issue.

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20. Are there any restrictions after implanting a CRT?

If you have a CRT implanted, you cannot do welding. You will need to use your mobile phone on the opposite side ear and keep it in your pant pocket or handbag. You need to keep 6metres away from high tension electric wires and transformers. You will need to avoid being close to gadgets that cause electric vibrations like electric power drills, motorboat engines, physiotherapy involving TENS [transcutaneous electric nerve stimulation], and shortwave diathermy. You can use bluetooth ear-phones.

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21. Do I have an increased risk due to a CRT from lightning killing me?

No, the risk of you dying from lightning is the same as that of anyone else.

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22. When can I resume normal activity after the procedure?

You can resume normal activity within 4-6 hours after the procedure. It is advisable that you do not lift your arm above shoulder level on the side of the procedure for 6 weeks after the procedure. This will help your wound to heal and prevent the lead from getting dislodged.

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23. When can I resume driving?

If you had an abnormal heart rhythm, then you will have to wait for 6 months of no such life-threatening rhythms to resume driving. If you have not had any sudden cardiac death-like event or any abnormal rhythm, then you can start driving 6 weeks after the procedure.

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24. Can my doctors monitor my heart rhythm through the CRT from far away?

Yes, it is possible to monitor your heart rhythm through a remote monitoring device. This device is the size of a mobile phone and it can continuously transmit your heart rhythm to the hospital where it can be monitored. This remote transmitting device needs to be purchased separately and costs approximately between Rs. 60,000 and Rs. 1,00,000 depending on the device model and company. 

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26. When should I come for my next check-up after the CRT is implanted?

You ideally need to come 6 weeks to 3 months after your procedure, for us to make sure that the device is properly fixed and functioning to our satisfaction.

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27. How frequently do I need to have my machine checked?

You need to have a yearly check-up after the CRT is implanted. If you experienced a shock, then it is advisable for you to come for a check-up within 1 month of the same.