Biventricular Device Implantation - CRT
We are now implanting a recently developed device – the biventricular pacemaker or defibrillator. The biventricular device has been demonstrated in prospective randomized trials to be useful in select patients with congestive heart failure and electrical conduction disease. This type of therapy has been termed cardiac resynchronization therapy (“CRT”) and involves implantation of a pacemaker or defibrillator that has 3 pacing leads. Two of these leads are similar to those used in standard dual chamber pacemakers or defibrillators, with one lead placed in the right ventricle and the other in the right atrium. The biventricular device is distinguished by the presence of a third lead that is advanced through the coronary sinus (the heart’s venous drainage, located in the right atrium) to a cardiac vein that lies adjacent to the left ventricle. This type of device delivers a paced ventricular impulse simultaneously to both the left and right ventricles to better coordinate contraction of the two ventricles. This approach decreases symptoms in patients with severe congestive heart failure, decreases the need for intravenous medical management, and reduces hospitalization. Placement of the third lead is technically challenging and occasionally not possible because of variation in the anatomy of the veins of the heart. Some patients do not have veins that can be used for left ventricular pacing, a fact that can be established only at the time of attempted implantation. After placement of the three leads, the remainder of the procedure is performed as described in the
"Internal Cardioverter Defibrillator (ICD) Implantation" section.
