A biventricular pacemaker is a special device that improves heart function by stimulating both ventricles synchronously in heart failure patients. It is also known as cardiac resynchronization therapy (CRT).
What is a Biventricular Pacemaker?#
Unlike a standard pacemaker, a biventricular pacemaker stimulates both the right and left ventricles simultaneously. This allows both sides of the heart to work in sync and increases pumping efficiency.
Device Components:
- Generator (battery and electronic circuit)
- Right atrium electrode
- Right ventricle electrode
- Left ventricle electrode (via coronary sinus)
How Does a Biventricular Pacemaker Work?#
Conduction delay (left bundle branch block) is frequently seen in heart failure:
- Left ventricle contracts late
- Heart works inefficiently
- Symptoms worsen
Biventricular pacemaker:
- Stimulates both ventricles simultaneously
- Provides synchronized contraction
- Increases cardiac output
- Reduces symptoms
Biventricular Pacemaker Indications#
Definite Indications#
- Sinus rhythm
- Left bundle branch block (QRS ≥150 ms)
- Ejection fraction ≤35%
- NYHA class II-IV symptoms
- Symptomatic despite optimal medical therapy
Possible Indications#
- Wide QRS without left bundle branch block (≥150 ms)
- Atrial fibrillation + low EF
- Patients requiring high rate of ventricular pacing
- Pacemaker upgrade (from existing pacemaker to CRT)
Types of Biventricular Pacemaker#
CRT-P (Pacemaker)#
- Pacing function only
- In patients with low sudden death risk
- Smaller device
- Longer battery life
CRT-D (Defibrillator)#
- Pacing + defibrillation
- In patients with high sudden death risk
- Most commonly preferred type
- Includes ICD function
Biventricular Pacemaker Implantation#
Pre-Procedure Evaluation#
- Echocardiography (EF, dyssynchrony)
- ECG (QRS width and morphology)
- Coronary sinus anatomy (venography or CT)
- Blood tests
- Anticoagulant adjustment
Procedure Steps#
- Anesthesia: Local anesthesia + sedation
- Vascular access: Subclavian or axillary vein
- Right atrium electrode: Placement in right atrial appendage
- Right ventricle electrode: To right ventricular apex or septum
- Left ventricle electrode: To lateral vein via coronary sinus
- Testing: Threshold and sensing check
- Generator implantation: Placement in subcutaneous pocket
- Closure: Skin closed with sutures
Procedure Duration#
Biventricular pacemaker implantation usually takes 2-4 hours.
Biventricular Pacemaker Results#
Expected Improvements#
Short Term:
- Reduction in shortness of breath
- Increase in exercise capacity
- Improvement in quality of life
Long Term:
- Increase in ejection fraction
- Reduction in heart size
- Decrease in hospitalization rate
- Survival advantage
Response Rates#
- 70% of patients respond to CRT
- 30% may be “super responders”
- 30% may not respond adequately
Biventricular Pacemaker Risks#
Procedure risks:
- Left ventricle electrode placement failure (5-10%)
- Coronary sinus dissection
- Phrenic nerve stimulation
- Infection
- Pneumothorax
- Electrode dislocation
Frequently Asked Questions#
Does a biventricular pacemaker cure heart failure?
Is biventricular pacemaker implantation painful?
How long does a biventricular pacemaker battery last?
What if I don't respond to CRT?
Can I lead a normal life with a biventricular pacemaker?
Appointment and Contact#
If you would like to schedule an appointment for biventricular pacemaker evaluation:
📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content has been prepared by Assoc. Prof. Dr. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.
Related Arrhythmia Treatments#
Other arrhythmia treatments related to biventricular pacemaker:
- Heart Failure - Heart failure treatment
- ICD - Implantable cardioverter defibrillator
- Permanent Pacemaker - Bradycardia treatment
- Echocardiography - Heart ultrasound
- EKG - Electrocardiography