Biventricular Pacemaker Implant
A biventricular pacemaker, also known as cardiac resynchronization therapy (CRT), is a relatively new approach to tackling heart arrhythmia. The pacemaker is implanted to normalize heart rhythm, and alleviate symptoms associated with irregular heartbeats. It corrects for the problem that, in approximately 30 percent of heart failure patients, the ventricles, the lower chambers of the heart, do not pump blood at precisely the same time, decreasing efficient blood flow. A biventricular pacemaker is implanted only when medication has not been effective in treating arrhythmia.
Candidates for a Biventricular Pacemaker
CRT is generally prescribed for patients with moderate-to-severe symptoms of heart failure, whose left and right ventricles do not beat at the same time. This problem may be caused by lifestyle choices, such as smoking, or alcohol or drug abuse, as well as by a number of cardiac conditions. Heart arrhythmia can also be genetic, idiopathic or stress-related.
Benefits of a Biventricular Pacemaker
By ensuring increased efficiency in heart function, a biventricular pacemaker increases blood flow, typically relieving congestive heart failure symptoms, such as shortness of breath. In addition, it has been shown to reduce the size of the left ventricle and improve its ejection fraction, the percentage of blood that leaves the heart each time it contracts. These positive effects decrease patient hospitalizations and lower patient mortality rates.
The Biventricular Pacemaker Implant Procedure
During the procedure, a pacemaker, approximately the size of a half dollar, is implanted right below the patient's collarbone. The device is connected by wires to a monitor set up to detect any irregularities in the heartbeat. When arrhythmia is detected, the device corrects it with tiny electrical pulses.
Complications of a Biventricular Pacemaker
Implantation of a biventricular pacemaker is very safe but, as with all medical procedures, complications are possible. In this case, complications include possible infection or residual pain.
Biventricular Pacemaker plus Cardiac Defibrillator Implant
A biventricular pacemaker is used to synchronize the contractions of the right and left ventricles (lower chambers) of the heart. Used to treat moderate-to-severe symptoms, such as shortness of breath, swelling of the ankles and legs, and a dry cough, of congestive heart failure, a biventricular pacemaker improves the rate at which the heart pumps blood into circulation, a rate known as ejection fraction.
An implantable cardiac defibrillator (ICD) is a small electronic device implanted in the patient's chest to prevent life-threatening cardiac arrest due to tachycardia (abnormally rapid heart rate). While the biventricular pacemaker is installed to keep a patient's heart rhythm regular, the ICD is implanted as a protective device to activate during emergencies. The ICD, like the biventricular pacemaker, is also capable of monitoring heart rhythm. When the rhythm is regular the device remains inactive. It is only if the heart develops a dangerous arrhythmia or tachycardia that the ICD activates, delivering an electrical charge to the heart to return its rhythm to normal.
In patients who not only have heart arrhythmia, but are in danger of life-threatening heart fibrillation, the biventricular pacemaker and cardiac defibrillator are implanted to perform two functions simultaneously: alleviate the symptoms of heart failure and prevent fibrillation from causing death. In a patient who has the combined implants, not only is quality of life improved, the potential to reestablish normal heart rhythm after fibrillation is in place. This enables immediate electrical intervention during a cardiac event that might otherwise lead to irreversible brain damage.
Although external defibrillators (portable units that deliver electrical shocks to the heart) can also be used in an emergency, there is always the danger that they are not available when needed. For this reason, it is wise for patients known to be at risk for developing life-threatening tachycardia to have ICDs, as well as biventricular pacemakers, implanted. The combination helps to ensure their safety and avert potential cardiac arrest.
Implantable Device Management
In recent decades, the implantation of devices that control heart rhythms (pacemakers) and protect susceptible patients from cardiac arrest (defibrillators) has increased exponentially. Pacemakers and defibrillators are managed in a number of ways. Patients receive and carry wallet-sized identification cards with their doctors' emergency contact information, and the devices are checked periodically to make sure they are in good working order. Like other electronic devices, pacemakers and defibrillators have a lifespan that depends, to an extent, on how many times they are activated. An old device and its leads have to be monitored to ensure that they are replaced when necessary. Minimally invasive surgery is needed when a device or its leads require replacement.