What happens during the procedure
The device is inserted just under the collar-bone on the front of the chest usually on the left side. The area is prepared with a special sterile solution that may feel cold. You will be covered by a large sterile sheet that will partly cover your face. You will be able to look out from under the sheet to the side and a nurse will be present at all times. You will be given oxygen to breathe by a small tube that is positioned under your nostrils or by a mask that covers your face.
At the start of the procedure, the doctor will inject local anaesthetic into the area under the collar-bone where the CRT device is to be inserted. This will sting momentarily but the area will then be numb. During the procedure you may feel some firm pushing in the shoulder area but this should not be painful. If you experience pain or discomfort you should tell the nurse or doctor.
Three leads (special wires which connect the CRT device with the heart) are inserted into the heart via the vein under the collarbone. These are manipulated into the heart under X-Ray control. Initially the standard leads are inserted first, one into the right atrium and one into the right ventricle. These leads attach to the heart wall either with small hooks or with a small screw. The coronary sinus is accessed using a small thin tube (called a sheath) and the left ventricular lead is passed via the sheath into a lateral branch of the coronary sinus. All three leads will then be connected to the CRT device.
Sometimes it is not possible to pass the third wire into the coronary sinus due to its shape. A possible option in these situations is referral to a cardiothoracic surgeon to implant the lead via a limited open surgical approach at a second procedure. This will be discussed with you if the LV lead cannot be implanted successfully.