CRT-D: A Fresh Lease of Life For Your Heart !

Issues with the heart are always a cause for concern. Being one of the most important organs of the human body, any trouble to the heart does ring alarm bells. Thanks to our lifestyle, heart conditions are becoming very common, However, advanced medical facilities have been able to tackle some of these life threatening problems effectively.

One such procedure is CRT-D. Would you believe it if we told you that it gave a 90-year-old a fresh lease of life?

Mr Radhanath Bhanja (name changed) from Odisha suffered from a heart attack 15 years ago. Consequently, he had a bypass surgery. Over the following years, however, his heart’s pumping function, known as Ejection Fraction (EF) in medical terms, deteriorated. EF is the amount of blood that the heart pumps out each time it contracts. For an average person, it ranges from 55% to 70%. A lower percentage indicates a weaker heart. By the time Mr Bhanja reached us at Sri Sri Holistic, his EF was only 20%.

His kidneys had started to fail, and water was accumulating in his body. His abdominal area was so swollen that he had difficulty even in basic movements like walking or lying down. He felt breathless all the time.

The doctor found it fit to implant a CRT-D to address his issue. A CRT-D or Cardiac Resynchronisation Therapy with Defibrillator is a medical device used in patients who have severe  heart failure with left bundle branch block on ECG. (LBBB is a problem with electric conduction in the left bundle of the heart).

CRT-D

The heart has to be electrically kick started every time it beats. The electricity is generated in a small structure in the right upper chamber of the heart.

Thereafter the electricity flows though the upper chambers causing them to to contract and empty blood into the lower pumping chambers. Then the electricity flows though two seperate bundles called the left and right bundles supplying the respective pumping chambers  ventricles). When the heart’s pumping function decrease ( usually after a heart attack or viral infection that destroys part of the heart’s muscle) it enlarges. This causes stretching of the conduction fibers causing short circuits. These short circuits might happen any time causing the heart to beat rapidly and erratically at around 300-400 times a minute. At this speed the heart is no longer able to pump blood and just quivers like a bag filled with worms. This is called ventricular fibrillation and 3/4th of patients with severe heart failure ultimately succumb to this problem.

The only way to predict this problem is the Ejection fraction ( EF) on the echo-cardiogram. If the EF is less than 35% these people need to have a device called Automatic Implantable Defibrillator ( AICD) implanted underneath the skin of the chest. The Defibrillator continuously monitors the heart rate. If the heart is beating very fast the device automatically delivers a shock internally to wipe out these short circuits in the heart. Therefore this in like an insurance policy preventing sudden death in these patients.

The Left bundle conduction system supplies the left ventricle and cause the whole left ventricle to move in one go. If this bundle is cut (Is called left bundle branch block or LBBB in short and is easily detected on the ECG and  happens in 25% of heart failure cases) the vetricle is activated slowly as electricity flows slowly throgh the heart muscle instead of flowing rapidly through the left bundle. The heart now contarcts in bits and pieces (dysynchrony). This is corrected by simultaneously activatiing the left  ventricle with two wires; one on the right and one on the left side of the ventricle. Lucily there are veins on the left side of the heart. There for there is no need to open the chest for this procedure. The wires are put though the veins in the cath lab.

The procedure takes around two hours and the patient can be discharged the same day after implanting a battery powered device underneath the skin of the left chest. This is called Cardiac Resynchronization therapy pacing ( CRT or CRT-P) and is also known as Biventricular pacing. It improves the puping fuction of the heart and in many people the EF improves by 10-30%.

Therefore all patients with EF less than 35% need an AICD ( Defibrillator).  1/4th of these patients also need a CRT-P if they have LBBB as this can improve pumping. The comination of these devices is called a Combo or CRT-D which prevents sudden death as well as improves pumping.

After the implantation, Mr Bhanja’s EF increased to 40%. This improvement is a remarkable one, especially at such an advanced age and after serial heart attcks. Soon after the surgery his kidney function normalised and his body shed the extra fluid. He goes for his morning wals and feels confident about travelling without aides as feels confident that he is protected.

CRT-D has proved to be a significant invention in the medical field. It is a lengthy procedure and involves a certain degree of risks. But when done efficiently, a successful CRT-D implantation can now cure most severe heart conditions which could otherwise turn to death in a matter of minutes!

About the Hospital: 

Sri Sri Holistic Hospitals is a leading group of hospitals located at Nizampet Road and KPHB ( Sri Sri Holistic Prime) in Hyderabad and at  Kadapa, with mutispeciality clinics/ emergency centres at Pragati Nagar and Sanghareddy.  Sri Sri Holistic Hospital provides high standards of healthcare with a combination of advanced technology and state of art clinical expertise. With more than 52 Internationally experienced doctors and 400+ staff, we served at least 50,000 patients so far.