Another setting question

I know there have been several posts about this topic but I am still a little unsure about which works best rate response on or off. PM since 2/10. Just released last month for exercise. Started on a masters swim program 2 weeks ago. I was having a hard time after warm up and blamed it on being out of shape until today.

I was working out at home today and found that as soon as my heart rate reached 135 my HR went down to 70 and my blood pressure went sky high 180/110. So I then tested it. I slowed down, my blood pressure came down and my heart rate started to come up slowly. Then again, over 135, HR went back down to 70 and feel the same way I do when swimming.

So, I know my settings are off. I am going to ask for my EP to put me on a treadmill which we had talked about but wondering if RR is better on or off? I have issues with tachycardia/arrythmia and on Flecainide which has been effective.

It is frustrating when you are ready to get back in the "game" but the heart does not follow:)

Thanks in advance for your feedback!
Heidi

4 Comments

Settings

by ElectricFrank - 2010-08-01 02:08:45

The problem you are describing sounds like it is related to the Upper Pacing Limit setting. The way this works is that when your HR reaches the upper limit the pacer starts skipping beats to keep the average rate less than the limit. While this is effective in limiting pacer mediated tachycardia, it creates a very inefficient heart rhythm. It kicks in at a time when your exercise level requires a higher heart rate to support it and your body reacts by raising BP in an attempt to provide blood flow. (Your EP likely won't agree with my last statement, but I have seen in in my own setup).

There is really only 2 possible approaches to the situation. The best is to have the upper limit raised to 150 or so as long as this doesn't cause problems with VTach. The other is to limit your exercise level enough to stay below the upper limit. I don't think that pushing it beyond the upper limit is a good idea at all for the reasons I mentioned above.

Have you looked at the professional prescribing information for Flecainide? This is a serious med that I wouldn't take unless I absolutely had to.

A good description is at:
http://www.drugs.com/sfx/flecainide-side-effects.html

As for the Rate Response it depends on whether you are having problems with sinus pacing. If you have a normal atrial rhythm then having it off is much better.

hope this helps,

frank

Taisha

by Taisha - 2010-08-01 03:08:27

I had a pacemaker from february same problem no response when going up hills. Asked for an early check up and if the rate response was on, they put it on and later they put the upper limit to 150. I am not sure if the rate response or the upper limit improved how I felt. Either way I think pacemakers are slow to respond to increased exercise demands compared to normal hearts, at least thats how it feels to me. You have to have a longer warm up time and a slower cool down. By rights as Frank says if your sinus nodal rhythm is ok you shouldnt need rate response and I'm thinking of getting it off and seeing how that goes. I am also wondering how pacing a lot in the right ventricle which can lead to left sided heart failure and rate response work if anyone has any info about that ta

Rate Response

by donb - 2010-08-01 09:08:13

After having a RCA stent implant a few years ago I participate in Phase11 and now Phase111 Cardiac Rehab. My 3rd PM was Medtronic Enrthymn PM with RR turned on with limits set at 60-130. I found that my RR would pick up my HR very quickly doing treadmill workout. It would take me to 130 too fast and then drop to 70 or less giving me normal ill effects. It was great for doing a short burst of exercise ( made you feel like a Kid again) but no endurance.

I only had this PM about 2 years as it eroded and I now have a St. Jude 5820 since 2/08/2009. My RR is off and my endurance on all my rehab exercise is double, same doing yardwork. I do miss the youthfull burst of energy which is really cheating at age 78. Maybe a good feature for me would be an external gadget for me to set the response curve for my needs. I'm sure Frank would go for that!! Mother Nature sure gave most of us a good electrical control over our hearts and maybe some day our electronic wizzards will come closer to duplicate our hearts needs. donb

New settings today!

by Heidiglassmeyer - 2010-08-05 01:08:07

Thank you Frank for your info. Had my upper rate increased to 180 today (I am 41) and looking forward to my workout on Friday! I was glad to hear my VTach is still under control and he was willing to set it that high. Hopefully I am set now. Thank you for your feedback. I never realized that it may take several changes to my settings to get everything right. By the was my RR is off.

Heidi

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