Cardiac resynchronisation therapy (CRT / biventricular pacemaker)

What is cardiac resynchronisation therapy (CRT)?

Cardiac resynchronisation therapy, or CRT, uses a special pacemaker — often called a biventricular pacemaker — to help a weakened heart pump more efficiently. In some people with heart failure, the two main pumping chambers no longer contract together. CRT sends tiny electrical signals to both sides so they beat in time again.

Unlike a standard pacemaker, which usually has one or two leads, a CRT device has an extra lead that reaches the left side of the heart through a vein on its surface. It is fitted through a small cut below the collarbone — a procedure, not open-heart surgery.

There are two main versions. CRT-P is a resynchronisation pacemaker. CRT-D combines resynchronisation with a built-in defibrillator that can also treat dangerous fast rhythms. Which one suits you depends on your heart and your risk, and NICE sets out who each is recommended for.

CRT can ease breathlessness and tiredness and help some people do more, but it is not a cure for heart failure, and not everyone responds. You still need your heart-failure medicines, and the device needs lifelong checks.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

CRT-P compared with CRT-D

Whether you need the defibrillator function depends on your individual arrhythmia risk. NICE guidance and your cardiologist guide the choice. This is a guide, not advice.

Preparing for your procedure

• See the cardiologist who will fit the device; ask whether CRT-P or CRT-D is planned and why.
• Bring a full list of your medicines; you will be told which to continue and whether any blood-thinners need adjusting.
• Tell the team about any allergy, kidney problems, or previous device or chest surgery.
• You may be asked not to eat for a few hours beforehand; follow the instructions you are given.
• Arrange a lift home and help at home, as you should not drive for a period afterwards and must rest the arm on the implant side.
• Plan for limited use of that arm for a few weeks — no heavy lifting or reaching high.
• Ask about the driving rules that will apply to you, and tell the driving authority — the DVLA in England, Scotland and Wales, or the DVA in Northern Ireland — if you hold a lorry or bus licence.

What happens

The device is usually fitted under local anaesthetic with sedation, so you are relaxed but the area is numbed; occasionally a general anaesthetic is used. You lie flat while a small cut, around 5 to 6 centimetres, is made just below the collarbone, usually on the left.

The leads are passed into a vein and guided to the heart using X-ray. CRT needs an extra lead positioned in a vein on the surface of the left side of the heart, which is why the procedure usually takes longer than a standard pacemaker and is not always straightforward. The leads are connected to the device, which sits in a small pocket under the skin.

The team tests that the device is working before closing the small wound. Most people stay one night so the device can be checked and the wound observed. You will be shown how to look after the wound and given a device identification card to carry.

Is this procedure right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

The extra left-sided lead makes CRT more involved than a standard pacemaker, and occasionally it cannot be positioned as hoped. Device-pocket infection is uncommon but serious and can mean removing the whole system, so report any redness, swelling, heat or discharge promptly. Ask your cardiologist about your personal risk and what to expect if the left-sided lead proves difficult.

Published figures to discuss

Complication rates depend on the operator, your anatomy and the difficulty of placing the extra left-sided lead. Figures below come from device-implant research and audits and are a guide, not your personal risk. Note that some published rates are for standard pacemakers; CRT can carry somewhat higher procedural risk because of the additional lead.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

Most people are home the day after the procedure and feel back to normal within a few weeks, though the arm on the implant side needs care while the leads settle into place. Any benefit to your heart-failure symptoms usually builds gradually over weeks to months rather than immediately.

• Bruising, soreness and a visible bump at the device site that settle over a couple of weeks
• Shoulder or arm stiffness on the implant side early on
• Feeling tired for the first week or so
• A gradual, rather than instant, improvement in symptoms — and sometimes little change at first

Aftercare

• Keep the wound clean and dry and follow the dressing advice you are given.
• Avoid lifting the arm on the implant side above shoulder height, and avoid heavy lifting, for the first few weeks.
• Do not drive until you are told it is safe — usually at least a week for a CRT-P, longer for a CRT-D.
• Carry your device identification card at all times.
• Keep taking your heart-failure medicines unless told otherwise.
• Attend all device checks so the battery, leads and settings can be monitored.
• Ask before any MRI scan, and tell other health staff and security staff that you have a heart device.

• Help at home arranged for the first week or two
• Time off work and off driving booked (at least a week, longer for a CRT-D or Group 2 licence)
• A sling or reminder to rest the implant-side arm, if advised
• Loose clothing that does not rub the wound
• Device identification card kept on you
• The driving authority informed if you hold a lorry or bus licence — the DVLA in England, Scotland and Wales, or the DVA in Northern Ireland
• The clinic's contact number saved for wound or device concerns

Scars and how they heal

You are left with a small scar, usually about 5 to 6 centimetres, below the collarbone, with a visible bump where the device sits under the skin. The scar fades over months. In thin people the device can show through the skin more; rarely it can press on the skin and need attention.

⚠ Get urgent help if…

• Spreading redness, swelling, heat, discharge or a wound that opens — possible device infection; seek urgent advice
• Fever or feeling generally unwell in the weeks after the procedure
• Severe or increasing breathlessness, or your heart-failure symptoms getting suddenly worse
• Fainting, blackouts or a fast, pounding heartbeat
• If you have a CRT-D and it delivers a shock — follow the advice you were given (one shock and feeling well: contact your team; repeated shocks or feeling unwell: call 999)
• Persistent hiccups or twitching in time with your heartbeat (a lead may have moved)
• Severe pain, swelling or breathlessness soon after the procedure (possible bleeding or air around the lung)

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A good result means the device paces both sides of the heart together and, over weeks to months, you breathe more easily and have more energy. Some people respond well, but a meaningful proportion notice little benefit even when the device is correctly fitted — this is an important, honest part of the discussion before you decide.

CRT does not cure heart failure. You still need your heart-failure medicines and ongoing monitoring. A CRT-D can also stop a dangerous rhythm, but living with a defibrillator brings its own considerations, including the possibility of shocks and stricter driving rules.

The device runs on a battery sealed inside it. Battery life varies with the device type and how much pacing you need, typically several years, after which the unit is replaced in a further, usually shorter, procedure (a 'box change'). The leads are designed to last much longer, but they can occasionally move, wear or fail over the years and may need repositioning or replacing, which can be more involved than the first implant.

Related tests, treatments or support

CRT is part of a wider heart-failure plan that includes medicines and lifestyle measures, and it does not replace them. Some people have the resynchronisation lead added to an existing pacemaker or defibrillator as an upgrade. Decisions about CRT-P versus CRT-D, and about any defibrillator, are made together based on your heart and your risk.

Follow-up & long-term care

You will have device checks, sometimes remotely from home, to monitor the battery, the leads and the settings, and to fine-tune the pacing. Heart-failure care continues alongside, often shared between your cardiology team and GP. Tell any clinician you see, and security staff, that you have an implanted heart device.

• Attend all scheduled device checks, including remote monitoring if set up
• Plan for an eventual battery-replacement (box change) procedure after several years
• Carry your device identification card and show it at airports and hospitals
• Keep taking heart-failure medicines and attending heart-failure reviews
• Ask before any MRI scan, as the device must be checked for compatibility and managed
• Report shoulder twitching, hiccups in time with the heartbeat, or any shock from a CRT-D

Repeat, follow-on and what comes next

• The battery is sealed in the device and is replaced after several years in a further procedure.
• Leads can move, wear or fail over time and may need repositioning or replacing, which can be more involved than the first implant.
• The left-sided lead occasionally cannot be placed as planned, so resynchronisation may be delivered differently or not at all.
• A CRT-D may need lead or generator revision, and inappropriate shocks sometimes need the settings adjusted.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• Clear written driving advice specific to your device (CRT-P or CRT-D) and licence type.
• A device identification card and a plan for regular checks, including remote monitoring.
• A named contact for wound or device concerns, and clear advice on what a shock from a CRT-D means.
• Continued heart-failure care, shared between cardiology and your GP.
• Honest review of whether you have responded, and what to do if you have not.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Whether a CRT-P or the more complex CRT-D device is used
• The cardiologist's (operator's) fee and the cath-lab/facility fee
• The device and leads themselves
• Sedation or general anaesthetic, and the overnight stay
• How difficult the left-sided lead is to position (which can lengthen the procedure)
• Ongoing device checks and remote monitoring
• The eventual battery-replacement (box change) procedure years later

• The cardiologist's fee and the cath-lab/facility fee
• The cost of the device (CRT-P or CRT-D) and leads
• Sedation or anaesthetic costs and the overnight stay
• Follow-up device checks and remote monitoring arrangements
• What is covered if a lead needs repositioning or the device needs revising
• The cancellation policy
• What happens, and what it costs, if a complication or longer stay is needed

On the NHS? CRT is provided by the NHS for people who meet NICE criteria; private care is usually chosen for speed or choice of cardiologist, not because the device is otherwise unavailable.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the specialist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good specialist will welcome every one of these.

• Am I likely to be a responder, and what is the chance I notice little benefit?
• Do you recommend CRT-P or CRT-D for me, and why?
• Exactly what are my driving restrictions, and do I need to tell the DVLA (or the DVA in Northern Ireland)?
• What happens if the left-sided lead is difficult to position?
• How long is the battery likely to last before a replacement procedure?
• What should I do if I get a shock (CRT-D) or notice twitching or hiccups?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the specialist who carries out my procedure, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this procedure not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified specialist for cardiac resynchronisation therapy (crt / biventricular pacemaker)

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NICE TA314 — ICDs and CRT for arrhythmias and heart failure British Heart Foundation — Pacemakers (including CRT/biventricular) British Heart Foundation — Could a CRT pacemaker help my heart failure? DVLA — Cardiovascular disorders: assessing fitness to drive MHRA — CRT-P risk of loss of pacing therapy (device alert) DVLA — Assessing fitness to drive (general guidance) DVA Northern Ireland — Telling the DVA about a driver medical condition

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.