Setting PM Upper Limit

At 7 weeks I'm doing great. (At 4 weeks I basically forgot I had a PM.) On my interrog. at 7 weeks, they reported that my dual pacer was pacing 75% upper and 0.1%(essentially 0) lower chamber. I'm on a BB (Inderal LA) for BP and an atrial arrythmia that I had before PM. The Inderal seems to have done the job. I still have PVC's, my Medtronic showed some 3000 in a 6 week period which is negligible. Luckily they are infrequent and when they do happen last only a few seconds. I made a good choice in the clinic/doc after several years of suffering through exercise induced problems

I'm trying to get back into running. My upper limit is 140, I'm not in the best shape, fast walking at 4 m.p.h for an hour is no problem but running at 8 mt pace can get me only to 1/8 mile (on my limited first attempt-see below) when my breathing got labored. I talked to the doc about raising my upper limit and he said that it is a misunderstanding that raising the rate will necessarily lead to better performance. At least there are diminshing returns when your rate is already at the recommended level for age (I'm 63). I didn't argue because I'm a long way from being in shape, not having run any distance over 1/4 mile in 4+ years due to my bradycardia and I didn't want to sound like a smart ass when everything the doc has done so far for me has been outstanding.

I'm interested in any comments from the knowledgeable here about this recommendation to keep my upper at 140. Right now I can't run because I pulled a thigh muscle the first day I tried and I'm prepared to live with the 140 max till I can show lack of progress after regular running.


Also.. forgot to add..

by axg9504 - 2008-02-28 04:02:17

Doc said raising the upper limit should be done in conjunction with a change in the rate response and that might not be tolerated well because it might ramp up my rate unnecessarily for low level effort like walking..

PM upper limit

by Vai - 2008-02-29 02:02:10

Looks like you are having a smooth recovery and I am glad that the PM is working out fine for you. Those pacing readings of 75% upper and < 0.5% lower, PVCs sounds low. Maybe you can check out the afib load (just a percentage of afib incidence and total (or sum of) duration of afib over time. Your tolerance to the meds also appears to be good and the meds are just right for you. That is really wonderful. My readings are a little "worse" than yours, and my doc is satisfied that I am living normal now.

Your upper limit at 140 is not unfamiliar. When you run and you have labored breathing, I think its because you are not fit (same with me!). Its nothing to do with the upper setting. When I run and begin to have breathing labored, my monitored hr is somewhere at 120 bpm. My doc tells me I am not even pushing near the 140 limit and go see him only when I can push myself near that level. However he also said it is unlikely I would ever get there because of my BB meds.

Enjoy the quality of normal life when its restored!
Have a good one!


My natural pacemaker won't go to 150

by axg9504 - 2008-03-02 01:03:45

I know that for a fact, many sessions of heart monitoring with my Timex over the 3 yrs I put up without a PM showed that I would break at 140. I was just wondering about the doc's comment that it was a misunderstanding of many people that raising the upper limit would help one run further.

Vai: I'm not sure what you mean by afib load, at the last interrogation there was no mention made of any recorded afib, just PVC's. My exercise intolerance used to be accompanied by a junctional rhythm that was not a good feeling (throat clutching sensation). That seems to be gone with the Inderal.

I apparently burst a blood vessel in my left thigh, in hamstring area behind the knee. Noticed a nasty bruise a week after the event. But the pain's gone so I can run again. Will have to see if I can improve. It's been 5 years since I did any running and 30 since I ran consistently. But I'm determined, at least for now.

upper limits

by gevans - 2008-03-02 03:03:30

Hi Alex, just wanted to chime in to say that my PM (St Judes) only has an upper limit for the "rate response mechanism". My cardiologist said anything over the upper limit (105 in my case) is on my own. I regularly get it up to the 150's (when running) which is where he says I should back off (although I did reach 171 on my stress test).


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