resynchronisation therapy

Dr. Ignacio García Bolao, especialista en cardiología de la Clínica Universidad de Navarra
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Cardiac resynchronisation therapy  

Using pacemakers, cardiac resynchronisation therapy aims to solve the problems of a desynchronised heart rhythm, which can occur at both the intraventricular and interventricular level.

Biventricular pacemakers stimulate both ventricles, the right and the left, so that they contract simultaneously, thereby solving the problem.

Thus, biventricular pacemakers can improve the symptoms of heart failure.

If they are combined with the use of a defibrillator (defibrillator-resynchroniser), they can treat potentially malignant arrhythmias that can occasionally coexist in a patient with heart failure.

This surgery should be performed while hospitalised in order to monitor the evolution during the first few days after treatment. If everything progresses normally, patients can be discharged 2-3 days after the operation.

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The Arrhythmias Unit of the Clinic's Department of Cardiology is a reference centre for treatments related to heart disease.

If they are combined with the use of a defibrillator (defibrillator-resynchroniser), they can treat potentially malignant arrhythmias that can occasionally coexist in a patient with heart failure".

The implantation of biventricular pacemakers is very similar to that of conventional pacemakers. The device is generally implanted under local anaesthesia throughout almost all of the procedure.

During the implantation, an electrode is placed in the right atrium (through the subclavian vein) and two electrodes are placed in the ventricles: a conventional electrode in the right ventricle and a special electrode in the left ventricle, which is accessed through the coronary venous system (coronary sinus and its branches). These electrodes will stay permanently in their final location, connected to the pacemaker, which in turn will be implanted below the skin in the right infraclavicular region.

Recovery from the surgery is fast, and patients can be discharged from the hospital in two to three days. When the batteries run out (approximately every six years), the pacemaker needs to be replaced.

Candidates for undergoing this therapy are patients who are have severe heart failure and who also have signs of intraventricular dyssynchrony.

With intraventricular conduction disorders, such as left bundle-branch block, a simple electrocardiogram can detect the signs, which are confirmed by a cardiac ultrasound.

Learn more about cardiac resynchronisation therapy

Heart failure is a syndrome generally caused by a reduced capacity of the ventricles to contract.

However, in some patients with heart failure, the ventricles not only contract poorly, but also contract in a disorderly manner (desynchronised).

It is easy to imagine that if, in addition to contracting poorly, the heart contracts in a desynchronised fashion, the cardiac function will worsen, thereby worsening the heart failure.

Patients who carry a biventricular pacemaker can have an almost completely normal life. These patients only need to attend specific follow-up visits every three or six months and keep in mind a few precautions that will be explained by their physicians.

For what diseases is this indicated?

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Know what a heart failure is, how it is diagnosed and treatment [Infography-only available in Spanish]
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