CRT device when do I need one ?

CRT

by Tracey_E - 2024-06-14 17:26:07

EF is how hard the heart contracts when it beats. A CRT can't actually make it beat harder. It works by forcing the left and right ventricles to stay in sync. For some people, it's a miracle cure. For others, EF doesn't change much at all. If you are a good candidate is a question for your doctor.

35% is usually when they'll consider it so you are just there. 

A link...

by USMC-Pacer - 2024-06-14 19:50:04

Ultimately, your DR is the one to ask.. but here is a link for your information regarding the questions you asked:

LBBB typically sees good results from CRT especially where there is dyssychrony..

"CRT is recommended for symptomatic patients with heart failure (HF) in sinus rhythm with LV ejection fraction (LVEF) ≤35%, QRS duration ≥150 ms, and left bundle branch block (LBBB) QRS morphology. CRT should be considered for symptomatic patients with HF in sinus rhythm with LVEF ≤35%, QRS duration 130-149 ms, and LBBB QRS morphology. CRT should be considered for patients with HF in sinus rhythm with LVEF ≤35%, QRS duration ≥150 ms, and non-LBBB QRS morphology. CRT should be considered for patients with HF and LVEF ≤35% in NYHA class III or IV if they are in atrial fibrillation (AF) and have intrinsic QRS ≥130 ms, provided a strategy to ensure biventricular capture is in place. AV junction ablation should be added in the case of incomplete biventricular pacing (<90-95%) due to conducted AF."

Reference #5 from the link below:

https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/08/31/18/37/2021-esc-guidelines-on-cardiac-pacing-esc-2021

It should be a joint decision between you and your heart failure team

by Gemita - 2024-06-15 08:45:28

Moonchild, 

When do you need a CRT?  When you have tried other treatments like medication and lifestyle changes and failed to improve your symptoms/ejection fraction, or when your symptoms cannot be helped by any other means, you may need more invasive treatments to try to improve your condition.  Have you reached that stage?  

CRT could help with your low ejection fraction, left bundle branch block, an abnormal QRS, a history of heart disease, a past heart attack and cardiomyopathy.

I note you do not have a pacemaker or have any breathlessness, although you are getting some chest discomfort and other symptoms, including fatigue.

Guidelines in the UK are quite clear that CRT should be considered for a patient who is experiencing advanced heart failure, Class III or Class IV.  This is based on the New York Heart Association heart failure classification that despite optimal medical treatment, the patient shows no signs of improving.  The patient should also have a left ventricular ejection fraction of less than 35% and show signs of ventricular dyssynchrony.  The decision to offer a patient CRT should also be based on individual patient circumstances, so if you are symptomatic with extreme fatigue or experience other symptoms like poor exercise tolerance, you should tell your doctors.

I cannot answer your question about angina or the stiffness you experience, but any new chest pain should be reported promptly to your doctors for investigation, especially since you have a history of extensive heart disease.  They will perhaps need to rule out further blockages or other difficulties from your bypass surgery?

Tracey_E and USMC-Pacer have already given good, honest advice. 

A CRT procedure will be invasive so you need to be fit enough for surgery.  It can sometimes be difficult for the surgeon to achieve a good left ventricular lead position for optimum pacing and CRT success, so you need to go to an experienced surgeon for the best results. 

You are young and in your shoes, I would be concerned about leaving your ejection fraction where it is or the risk of it falling further and triggering unwanted heart rhythm disturbances, when a CRT device and possibly even a defibrillator might then become necessary. 

I would have a meaningful conversation with your heart failure team to discuss your concerns.  You could always seek a second opinion too.  On the other hand my sister had a fall in her ejection fraction to 16% and it has now recovered to 43% with medication alone, so sometimes the wait and see approach can work too.  A difficult complex decision and I wish you well

When do you need a CRT ?

by Moonchild - 2024-06-16 03:54:13

@Tracry_E Thank you for your suggestions Tracey .  I agree the doctor will have to decide the best way forward and the appropriate cry device to use .

@ USMCpacemaker Appreciate the link you have posted .Have read it , detailed and very useful information.

@ Gemita Thank you for taking the time to reply in such detail . I will take this discussion forward with the heart failure team as suggested and ask them to probe the reason for my chest stiffness further .

As of now I'm not symptomatic ( just feel tired at times ) , may be  they are not considering a CRT device now because I'm not there yet .

I agree , will have to go to a seasoned surgeon as pacing can be tricky . Will research for good doctors where I live .

Glad your sister's EF picked up well just medications. I will be patient and hope I see good improvement too .

Thank you again , I find your comments on various posts very useful. Glad you are sharing your knowledge with all of us 

When Do You Need a CRT?

by KHammond - 2024-06-17 08:58:04

I am in a similar situation with borderline symptoms that would indicate the need for CRT-P.  Original diagnosis Aug 2023 was sinus rhythm, RBBB, 2:1 AV block, bradycardia.  After dual lead Medtronic PM implant that August my left ventricle ejection fraction dropped from 65% to 43% on a recent cardiac CT scan and I am 100% paced in the right ventricle.  I do experience some shortness of breath with exercise but I am still very active with multiple sports and workout routines.  On my last visit just a few weeks ago they did all the pre-op paperwork prep as we await the results of another echocardiogram scheduled Jul 5th.  They said if my ejection fraction has dropped below 50% on the echo then CRT-P will be scheduled.  Some of the research that I have read seems to indicate a better long term outcome with earlier CRT intervention and I will have to trust my cardio team and their judgement.

KH