Exercise Limitations- This May Help

This relates to heart rate while exercising and to tweaking PM settings. Haven’t posted in awhile, but have lurked when time permits and see this subject frequently.

Background - I am 75 and have been active; hiking and skiing in the Northeast. Have had my pacemaker for almost 2 years. It has worked in that I am alive and haven’t had any syncopies.
The problem has been that when my HR gets up to 120 bpm I start to get skips every other beat. This not only is very uncomfortable, but I also have no endurance and my legs feel like lead. I’ve had several visits with the EP nurses and even the Doc once. Nothing they’ve done has helped (until yesterday).

Yesterday, they had a Medtronic Rep check my settings. Today I hiked and felt great for the first time in 2 years. This gets pretty technical. Here’s what he did, and the rationale -

My PM was set to Mode DDD and had a 240 ms sensing delay. To my understanding this means the PM waits 240 ms to sense the ventricular beat and if it doesn’t sense it, it paces you. Now think, when you exercise the time between beats is shortened yet the PM stays at the same sensing rate. That makes no sense. So, he changed my Mode to AAIDDD with MVP(minimal ventricular pacing). The Mode switches automatically from AAI to DDD when it senses my HR going up with exercise and they narrowed the sensing delay to 60 ms when in the DDD Mode.

The result is that in normal daily activities I am in AAI with 240 ms sensing to minimize pacing, but during exercise I go into DDD with 60 ms sensing. This is totally logical to me and best of all it seems to have worked. I got up to 133-4 bpm without getting the every other beat skip. Didn’t want to push beyond that on the first day with new settings.

Hope this may help some of you who are basically fit but are having similar issues. Best of everything to all. Feel free to PM me for any clarification.

Harry (Creaky)

2 Comments

Thanks Creaky

by Pookie - 2012-06-30 10:06:42

I too see this issue or something very similar to it from time to time on the site and your explanation was very easy to understand.

I remember back in 2005 & 2006 when I was having so many issues with mine, I would print off postings such as this (if I thought they seemed relevant to my problems) and would take them to my PM Tech when I was having my pacer interrogated. Unfortunately, my problem wasn't solved for almost 6 years, but it was something in the settings that 99% of the time is not even looked at - it's called Optimization - (which is part of the Rate Response feature of my Medtronics Enpulse). It was ON and when they turned it OFF, I got a lot of my life back. I was having issues very similar to Junctional Rhythm where my heart was always thumping really hard, but not fast. I was headed for an ablation until the PM Tech decided to adjust that one little setting!!!!!!!!

Sometimes I think a pacemaker is like a piano - it has to be finely tuned before it plays great music!!! :)

Again, thank you for taking the time to share this and hopefully it will help someone out there.

Take care,
Pookie

Know exactly what you mean

by ElectricFrank - 2012-07-01 01:07:50

I've found the Medronic reps to be very knowledgeable and helpful. They really know the device.

In my case it was just a matter of using DDD mode and setting the Upper Tracking Limit to 150bpm. At 82 yrs I have no intention of pushing my poor old heart to 150, but I will attend to the limit myself.

Mine like most had the Upper Limit set to 120 and as soon as I started walking briskly into a desert wind my heart reminded me of my old Model A Ford with a couple of loose spark plug wires.

I was up in the mountains at 8500ft a couple of weeks ago. I hiked one trail that is very steep along side a waterfall. I pushed my HR up to 130 which seemed fairly easy, and 135 about where I started to feel it. Only problem is that I developed an inflamed ankle which slowed me down. Never thought my legs would be the limit instead of cardio endurance.

By the way a few years ago I was up around 13,000' Jeeping in the Rockies, and then some short trail hikes. The pacer didn't complain at all.

I guess us old duffers have a bit left in us.

frank

You know you're wired when...

You get your device tuned-up for hot dates.

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