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Cardiac Resynchronisation Therapy (CRT) Pacemaker
Related Subjects: Chronic Heart Failure | Heart Failure and Pulmonary Oedema | Loop Diuretics | Entresto Sacubitril with Valsartan | Ivabradine | Furosemide | Angiotensin Converting Enzyme Inhibitors | Cardiac Resynchronisation Therapy (CRT) Pacemaker |
❤️🩹 Cardiac Resynchronisation Therapy (CRT) improves symptoms, exercise tolerance, and quality of life, and reduces mortality in patients with moderate-to-severe symptomatic heart failure (NYHA III–IV), sinus rhythm, LVEF <35%, and LBBB with wide QRS.
ℹ️ About
- Also called biventricular pacing or pacing in heart failure.
- Aims to restore ventricular synchrony when the ventricles contract out of phase.
- Often combined with an implantable cardioverter-defibrillator (CRT-D) for patients at risk of malignant arrhythmias.
🩺 Aetiology / Rationale
- Ventricular dyssynchrony (esp. due to LBBB) worsens LV function by inefficient contraction.
- CRT paces both ventricles ➝ coordinated contraction ➝ improved cardiac output.
- RV lead placed at apex, LV lead via coronary sinus to lateral LV wall.
- Resynchronisation helps prevent adverse remodelling of the failing LV.
✅ Indications for CRT
- NYHA III–IV heart failure despite optimal medical therapy.
- LVEF <35% with dilated LV.
- QRS >130 ms, esp. with LBBB morphology.
- In sinus rhythm (benefit in AF is less predictable).
📈 Effects & Mechanism
- Resynchronises ventricular contraction ➝ more efficient systolic function.
- Improves LV stroke volume and reduces mitral regurgitation by better papillary muscle coordination.
- Can promote reverse remodelling of dilated LV.
🌟 Clinical Benefits
- Improves exercise tolerance (6-minute walk distance, peak VO₂).
- Improves quality of life.
- Reduces heart failure hospital admissions.
- Reduces mortality in selected patients (e.g. CARE-HF, COMPANION trials).
💡 Teaching Pearl: Think of CRT when you see the triad of: 1️⃣ Symptomatic HF despite good medical therapy 2️⃣ LVEF <35% 3️⃣ Broad QRS with LBBB
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