Cardiac Resynchronisation Therapy pacemaker (CRT-P) or defibrillator (CRT-D)

Transcription

1 Cardiac Resynchronisation Therapy pacemaker (CRT-P) or defibrillator (CRT-D) Aftercare information for patients This leaflet tells you what to expect after having a CRT pacemaker or defibrillator implanted. If you have any queries, please do not hesitate to speak to one of the doctors or cardiac physiologists caring for you. What is the difference between a CRT pacemaker and a CRT defibrillator? A CRT pacemaker Improves and tunes the heart s contractions for more efficiency Helps the heart to beat in a regular rhythm, using wires to connect the device to your heart Runs the heart all of the time, regardless of your heart rate. We can change the settings during follow-up appointments if needed, A defibrillator Is for patients with fast irregular heartbeats. It prevents the effective contraction of the heart, which can lead to a life-threatening condition. If this happens, the defibrillator will pace or shock the heart back into a normal rhythm, Helps the heart to beat in a regular rhythm, using wires to connect the device to your hear. Pacemaker (CRT-P) How does a CRT pacemaker help my heart? It treats heart failure or a part of the heart that is not working very well. It makes the walls of the left ventricle (the main heart pumping chamber) contract and squeeze at the same time, and supports the heart to pump blood around the body better. Before you leave the clinic, we set the CRT so it works best for your heart condition. Will I feel different? In general, you should not notice the CRT working. If you had a very slow heart rhythm before the implant, you may notice your heart beating faster now. If you had fast palpitations before the implant, these might continue as the device does not usually stop your heart rate from getting faster. If this happens a lot, it can usually be treated with medicine. After a CRT implant, a few patients are sensitive to the device. This is known as diaphragmatic twitching, or hiccuping. This can usually be corrected by resetting the pacemaker.

2 Defibrillator (CRT-D) What do I do if it gives me a shock? When your heart beats so fast that it is life threatening, the device will deliver a full energy shock to get your heart back to its normal rhythm. Patients describe the feeling as being suddenly kicked or punched in the chest. It can be quite painful for a few seconds, and other times you won t feel the shock because you become dizzy. You may notice warning signs such as palpitations, or it may come on suddenly. If you have any warning signs, sit or lie down or let someone hold you. No harm will come to anyone who is touching you. After a shock you will recover quickly. Even if you feel well again, you should still contact the clinic to have your device checked. If you feel unwell after a shock, or you have several shocks, dial 999 for an ambulance and tell the paramedics that you have a device and what happened. Caring for your CRT device Do I need to stop taking my medication? This is different for each patient. Your cardiologist will advise you what to do, but with a CRT device it is normal to continue taking all medication. What happens when I leave hospital? For your own safety, you should not drive because the medication you had for the procedure makes you drowsy. Instead, ask someone to take you home. During the first 48 hours you may feel some discomfort in the area that has been treated. The doctor will advise you about what medication you can take for pain relief. If your symptoms become severe or long-lasting, please tell your GP or cardiac physiologist. Looking after your wound It should take about six weeks for your wound to fully heal. Keep the area clean and dry. Stitches (sutures) will dissolve on their own. If we used steri-strips and they do not come off on their own within 7-10 days, you can gently remove them in the shower while they are moist. Do not force them off. Do not scratch or rub the wound. Do not apply any ointments, creams or lotions on the wound until it is completely healed. If the wound rubs on clothing and causes discomfort, cover it with gauze. Change the dressing every day. You can take a shower 48 hours after having an implant: turn your back to the water nozzle to avoid direct water pressure on the wound. Use this technique for 7-10 days. You can have a bath, but keep the wound above water level until the scab is gone (7-10 days). If you have any of these symptoms at the wound site, call your doctor immediately, or if out of hours, go to your local Emergency Department (ED) as these may be signs of infection. redness soreness swelling bleeding oozing.

3 Activity guidelines for the first weeks after your procedure For the first six weeks: Walk it helps you to regain your strength and keep your heart healthy Do not lift objects that weigh more than 10 pounds Do not do too much in the first weeks. Stop any activity before you get too tired. Avoid playing all sports, especially contact sports as this may damage your pacemaker and leads Avoid activities where you push or pull heavy objects, such as mowing the lawn, shovelling snow or lifting suitcases. After the start of your recovery (usually after about four weeks), if possible, increase your level of activity. Speak to your cardiac physiologist about a healthy way of doing this, and to find out when it is safe to do strenuous activities. Arm movements After a few weeks, tissue will grow around the lead(s). This helps to keep them in place. In the first 6 weeks try to avoid lifting the arm that is on the same side as your CRT device. Do not lift it above shoulder level or stretch it out behind your back until you have had your first outpatient check. Once you have had your first device check and everything is ok, you can return to activities that are normal for you. When you touch the skin that covers the CRT device, you might feel some lumps. These lumps are the leads that are attached to the box; they are curled up beside the box under the skin. Do not try to move the box or leads. If they continue to bother you, please tell your physiologist. Driving The Driving and Vehicle Licensing Agency (DVLA) has guidelines that regulate the safety of patients with a pacemaker, and whether or not it is safe for them to drive. For more details, visit the DVLA site and search for pacemakers. Restrictions depend on why you have had your pacemaker fitted. It is important that you discuss this with your cardiac physiologist or doctor at your device clinic. They will explain this in more detail. You must tell the DVLA that you have had a pacemaker implanted. We strongly recommend that you tell your insurance company. Equipment that might affect your CRT device If your CRT device is near electrical equipment, it may temporarily affect its settings. Most household equipment, such as toasters, microwaves, blenders, TVs, VCRs, radios, CD players, hairdryers and shavers should be safe. If you are not sure, please check with your device clinic for advice. Mobile phones To avoid interference, do not carry an active phone near the device, but hold it on the opposite side. Do not keep your mobile phone in a coat or shirt pocket over your CRT device. Shop doorway security systems Walking through the system at a normal pace is fine, but do not stay in the area.

4 Arc welding You should avoid this if possible. There are exceptions, but please ask the clinic for more information. Magnets Do not carry magnets or put a magnet over your chest. Avoid carrying stereo or hi-fi speakers as they contain strong magnets. Medical equipment and hospital treatments Most hospital equipment will not cause any problems. However, we advise you to tell medical and dental staff that you have a CRT device, and to take your device ID card with you. We will give you an ID card at your first follow up appointment after surgery. If you go into hospital for any investigations or operations that are not about your pacemaker, you may find it useful to contact your implant centre for advice before you go. X-rays, CT scans and mammograms Avoid MRI (magnetic resonance imaging) machines. Some electrical nerve and muscle stimulators (TENS machines) may interfere with CRT devices, depending on their how they are applied. Contact your device clinic for more advice. Operations If you having an operation, you must tell your surgeon and anaesthetist that you have a CRT device implanted. If you have a combined CRT-defibrillator device, you may need to temporarily switch off (deactivate) the shock therapies for the operation. Sexual activity It is very common to not want to resume sexual activity, especially if you have a CRT-D. However, the device will not cause any harm to your partner, even if you have a shock during intercourse. Travel Walking through an airport metal detector archway does not harm your CRT device. However the device s metal casing may set off the airport security alarm, so we advise you to show security your identification card beforehand. Follow up appointments CRT device clinic visits Your pacemaker should be checked regularly. Your first device check will be about six weeks after surgery. The clinic offers remote monitoring (monitoring your heart and implanted device while you are at home) for all devices, but you will be seen at least once a year and may be asked to come into the clinic more often if necessary. At your visit, we will examine your CRT device for settings, battery life and leads. If your condition has altered, we may make changes to your CRT device s settings. We will give you an ID card for your CRT. You should carry this with you at all times in case you need medical attention. Changing your CRT Device A CRT Device battery usually lasts four to six years. Every time you visit the device clinic, we will check your battery. Cardiac physiologists will tell you when you need a new CRT box. They will let you know in plenty of time, and make arrangements at a time that is convenient to you, so that you won t have a low battery.

5 When you have your box changed, you will be admitted to hospital and have a similar procedure to when you had your first CRT device fitted. But you do not usually need new leads put in. Where can I find more information? Arrhythmia Alliance British Heart Foundation Who can I contact with queries and concerns? Hotline for shocks only Tel: , Monday to Friday, 9am 5pm Changing appointments You can phone , Monday to Friday, 9am 10am, or go to our Change of appointment form online at Care provided by students We provide clinical training where our students get practical experience by treating patients. Please tell your doctor or cardiac physiologist if you do not want students to be involved in your care. Your treatment will not be affected by your decision. PALS The Patient Advice and Liaison Service (PALS) is a service that offers support, information and assistance to patients, relatives and visitors. They can also provide help and advice if you have a concern or complaint that staff have not been able to resolve for you. PALS at King s College Hospital, Denmark Hill, London SE5 9RS: Tel: kch-tr.pals@nhs.net You can also contact us by using our online form at PALS at Princess Royal University Hospital, Farnborough Common, Orpington, Kent BR6 8ND Tel: kch-tr.palskent@nhs.net If you would like the information in this leaflet in a different language or format, please contact PALS on Corporate Comms: 1104 PL690.1 September 2015 Review date September 2018