Cardiac Resynchronisation Therapy in India

Cardiac Resynchronisation Therapy (CRT) is a specialised treatment used in patients with certain types of heart failure where the heart’s chambers do not beat in a coordinated manner. This lack of synchronisation reduces the efficiency of the heart’s pumping action, leading to symptoms such as fatigue, breathlessness, and fluid retention.

CRT involves implanting a small medical device, similar to a pacemaker, that sends electrical signals to both the left and right ventricles of the heart. These signals help restore a more coordinated heartbeat, allowing the heart to pump blood more effectively. Over time, this can improve symptoms, enhance exercise capacity, and reduce hospitalisations related to heart failure.

CRT is considered for patients with moderate to severe heart failure who continue to experience symptoms despite optimal medical treatment. It is recommended after careful evaluation to ensure that the therapy is likely to provide meaningful benefit. 

Situations Where CRT May Be Recommended

Heart failure with reduced ejection fraction

When the heart’s pumping ability is significantly weakened, CRT may help improve how efficiently blood is circulated throughout the body.

Electrical conduction delays (e.g., bundle branch block)

In some patients, delayed electrical signals cause the heart’s chambers to beat out of sync. CRT helps restore coordination between the ventricles.

Persistent symptoms despite medication

Patients who continue to experience breathlessness, fatigue, or swelling despite guideline-based medical therapy may benefit from CRT.

Frequent hospitalisations for heart failure

CRT may help reduce the need for repeated hospital admissions by improving overall heart function and stability.

CRT is primarily used in the management of chronic heart failure, particularly in patients with electrical conduction abnormalities.

Chronic Heart Failure (CHF)

In patients with weakened heart muscles, CRT helps improve coordination between the ventricles, enhancing pumping efficiency and reducing symptoms.

Dilated Cardiomyopathy

When the heart chambers become enlarged and weakened, CRT can help restore synchronised contractions and improve cardiac output.

Heart Failure with Left Bundle Branch Block (LBBB)

Patients with LBBB often have delayed electrical activation of the left ventricle. CRT helps correct this delay and improve overall heart function.

Not every patient with heart failure requires CRT. The decision is made after a detailed evaluation to ensure that the treatment is likely to provide meaningful benefit.

When CRT May Be Recommended

CRT may be considered if:

• Heart failure symptoms continue despite proper medication
• The heart’s pumping function is significantly reduced
• There is evidence of delayed electrical activity (such as LBBB)
• The patient is stable enough to undergo a device implantation

When CRT May Not Be Suitable

CRT may not be appropriate in certain situations, such as:

• Absence of electrical dyssynchrony
• Severe illness where overall benefit is limited
• Active infection or conditions that increase procedural risk

At Max Hospitals, eligibility for CRT is confirmed through a structured evaluation that includes echocardiography to assess heart function, an ECG to identify electrical delays, and a detailed review of current treatment and symptom status. This comprehensive approach ensures that CRT is recommended only for patients who are most likely to benefit from the therapy.

Cardiac Resynchronisation Therapy works by correcting the timing of electrical signals that control the heart’s contractions.

A specialised device is implanted under the skin, typically near the chest, with leads (thin wires) placed in specific areas of the heart. These leads deliver controlled electrical impulses to both ventricles, ensuring that they contract simultaneously rather than out of sync.

By restoring this synchrony:

• The heart pumps more efficiently
• Blood circulation improves
• Strain on the heart is reduced

Over time, this improved coordination can lead to better symptom control, enhanced functional capacity, and improved overall heart performance.

The type of CRT device used depends on the patient’s condition and risk profile.

CRT-P (Cardiac Resynchronisation Therapy Pacemaker)

This device provides pacing to both ventricles to improve coordination of heartbeats. It is typically used in patients who require synchronisation but do not have a high risk of life-threatening arrhythmias.

CRT-D (Cardiac Resynchronisation Therapy with Defibrillator)

In addition to resynchronising the heart, this device includes a defibrillator that can detect and treat dangerous heart rhythms by delivering a shock if needed. It is recommended for patients at higher risk of sudden cardiac arrest.

The choice between CRT-P and CRT-D is made after careful assessment of the patient’s heart condition, rhythm abnormalities, and overall risk factors.

CRT implantation is performed in a specialised cardiac catheterisation laboratory by an experienced team. Understanding the timeline can help patients and families feel more prepared.

Days Before the Procedure

In the days leading up to the procedure, patients undergo a detailed evaluation, including tests such as ECG and echocardiography to assess heart function and electrical activity. The medical team also reviews current medications and overall health, and may advise adjustments, such as temporarily stopping certain blood thinners.

On the day of the procedure, patients are usually asked to fast for a few hours beforehand. Final checks are completed, and the procedure is explained again before moving to the procedure room.

On the Day of the Procedure

The procedure is typically performed under local anaesthesia with sedation, so patients remain comfortable throughout. Thin leads are guided through blood vessels into the heart using imaging guidance, and the device is then placed under the skin near the chest. Once positioned, the system is tested to ensure it is functioning correctly.

After the Procedure

Patients are monitored in the hospital for one to two days while the device is checked and initial settings are adjusted. Before discharge, guidance is provided on caring for the implant site and gradually resuming daily activities.

Follow-up visits are scheduled over the following weeks and months to monitor recovery, assess device performance, and make any necessary adjustments.

Cardiac Resynchronisation Therapy offers several important benefits for patients with suitable indications:

Improved heart function

By restoring coordinated contractions, CRT enhances the heart’s ability to pump blood effectively.

Reduced symptoms

Patients often experience less breathlessness, fatigue, and swelling, making daily activities easier to manage.

Fewer hospitalisations

Improved heart function can reduce the frequency of hospital admissions related to heart failure.

Enhanced quality of life

With better symptom control, patients are able to participate more actively in everyday life.

Improved survival outcomes

In appropriately selected patients, CRT has been shown to improve long-term outcomes and reduce mortality risk.

CRT is generally considered safe, but as with any procedure, there are potential risks that are carefully evaluated before treatment.

Infection at the implantation site

There is a small risk of infection where the device is implanted, which may require treatment.

Lead displacement

The wires placed in the heart may occasionally shift position, requiring repositioning.

Bleeding or bruising

Some patients may experience bleeding or swelling at the implant site.

Device-related complications

Rarely, device malfunction or issues with electrical signals may occur and require adjustment.

No response to therapy

In some cases, patients may not experience significant improvement despite successful implantation.

The medical team carefully monitors patients after the procedure to detect and manage any complications early.

When managing advanced heart failure, access to specialised expertise and structured care plays a critical role in achieving better outcomes. The following aspects highlight how Max Hospitals supports patients undergoing CRT:

Experienced cardiac electrophysiology teams

Our specialists have extensive experience in implanting and managing advanced cardiac devices, ensuring precise and safe procedures.

Advanced cardiac diagnostics

Comprehensive imaging and diagnostic tools help accurately identify suitable candidates and guide treatment planning.

State-of-the-art catheterisation laboratories

Equipped with modern technology, our facilities support high-precision device implantation and monitoring.

Personalised treatment planning

Each patient’s therapy is tailored based on their specific heart condition, symptoms, and risk profile.

Integrated heart failure management

Beyond the procedure, we provide long-term care including medication optimisation, lifestyle guidance, and regular follow-ups.

Continuous monitoring and device optimisation

Regular check-ups ensure that the device settings are adjusted as needed to maximise therapeutic benefit.

Support for patients and families

Clear communication, education, and ongoing support help patients and their families navigate treatment and recovery with confidence.

How effective is Cardiac Resynchronisation Therapy?

CRT is effective for many patients with the right indications, helping improve symptoms and reduce hospitalisations. However, not all patients respond equally, and some may experience limited improvement despite correct device placement and programming.

Can CRT improve the structure of the heart over time?

In some patients, CRT can help the heart become more efficient and better coordinated over time. This may lead to gradual improvement in heart function, especially when combined with ongoing medical treatment.

Does CRT have any effect on heart valve problems?

In certain cases, CRT may help reduce leakage in the mitral valve by improving how the heart contracts. This can contribute to better overall heart function and symptom relief.

How many leads are used in a CRT device?

Most CRT devices use three leads. These are placed in different parts of the heart to help coordinate the timing between the chambers and improve overall pumping efficiency.

How soon can I return to normal activities after CRT implantation?

Most patients can return to light daily activities within a few days. However, movements involving the arm on the side of the implant may need to be limited for a few weeks to allow proper healing.

Can CRT help with abnormal heart rhythms?

CRT mainly improves the coordination of heart contractions, but in some patients, it may also help stabilise certain abnormal heart rhythms. In addition, CRT-D devices can actively treat dangerous rhythms if they occur.

Why is CRT sometimes preferred over a standard pacemaker?

In patients with heart failure, a standard pacemaker may not improve coordination between the ventricles and can sometimes worsen it. CRT is designed to maintain better synchrony, making it more suitable in such cases.

Who is eligible for CRT?

Patients with moderate to severe heart failure, reduced ejection fraction, and evidence of electrical dyssynchrony may be eligible, based on specialist evaluation.

Is CRT a permanent treatment?

Yes, the device remains implanted long-term and is monitored regularly to ensure proper function.

How long does the procedure take?

CRT implantation typically takes 2 to 4 hours, depending on individual complexity.

Will I be awake during the procedure?

The procedure is usually performed under local anaesthesia with sedation, so patients are comfortable but not fully unconscious.

How long is the hospital stay?

Most patients stay in the hospital for 1 to 3 days after the procedure for monitoring.

When can I return to normal activities?

Light activities can usually resume within a few days, but strenuous activity and heavy lifting should be avoided for several weeks.

Will I feel the device working?

Most patients do not feel the device. It works silently in the background to coordinate heartbeats.

How long does the device last?

The battery typically lasts 5 to 10 years, after which the device may need replacement.

Can CRT cure heart failure?

CRT does not cure heart failure but helps manage symptoms, improve heart function, and enhance quality of life.

Are there any restrictions after implantation?

Patients may need to avoid strong electromagnetic fields and follow specific precautions advised by their doctor.

What follow-up care is required?

Regular check-ups are needed to monitor device performance and adjust settings if required.

Can I travel after getting a CRT device?

Yes, most patients can travel once they have recovered, but it is important to carry device information and consult the doctor beforehand.

Reviewed by Dr Rajiv Agarwal, Vice - Chairman & Unit Head Cardiology, Cardiac Sciences, Cardiology, Interventional Cardiology, on 4 June 2026.