Concerned about holter monitor results

Just a short reminder: I narrowly avoided being shocked about 7 weeks ago due to an intense exercise class. I stopped going to the class and the Doctor said to wear a 24 hour holter monitor.

The results of the monitor revealed my lowest rate during those 24 hours was 57 and the highest was 122. My ICD is programmed at 70 for the lowest setting.

So my concern is....does this mean my device is not working properly? Or maybe a lead is not capturing again? Something cannot be right.

Waiting for test results seems like forever when it is your heart even though it was only a couple of weeks.

My big concern originally was to not get shocked. My new other concern is the 57 bpm when my lowest should be 70...give or take a few beats.

So I think I am going to stop any exercise for a while since I don't know which end is up now....57 or 200+.

Grateful Heart

11 Comments

We discussed it at length

by Grateful Heart - 2014-05-17 11:05:52

Decision is to do nothing right now...fine by me, I like it. Talked about a lot of possibilities in the future.

My question now is how can the monitor record a HR of 57 when my lower limit is 70? I searched the Internet and found nothing that talked about this.

I suppose one possibility is the monitor was defective but not likely. Beside, that would be too easy.

So, any ideas? Anyone else ever experience this?

Just seeking some answers.

Grateful Heart

Nothing to worry

by golden_snitch - 2014-05-18 03:05:18

Hi!

I honestly don't understand what makes you so worried about a heart rate of 57 that you want to stop all exercises. Yes, the ICD is set at 70, but maybe the holter recorded an artefact? Holters do that all the time, whenever you just move a bit too much. I have had holters recording pauses of 3 or 4 seconds when I was paced. Holter artefacts are VERY likely. Also, what if that 57 was due to a compensatory pause after one PVC? Absolutely normal, even if the pacer is set at 70.

If your cardio said everything's fine and nothing needs to be done, then why worry about the 57? If I were you, I'd continue to exercise.

Inga

Doesn't make sense

by Marie12 - 2014-05-18 07:05:57

I understood that a pacemaker setting of 70 meant your heart rate wouldn't go below that number. At least that is the way it was explained to me at my last interrogation. The pacemaker portion of my ICD is set for 60 and I never go below that. Even when completely at rest.

I think you are right to question your readings. Perhaps moderate exercise would be ok? I don't blame you for being cautious. With the heart rate numbers you have reached I would be concerned as well. Last thing we want is to be shocked.

???

by IAN MC - 2014-05-18 09:05:12

Grateful Heart How do you know that you " narrowly avoided being shocked " ?

I don't have an ICD myself but my understanding has always been that the defib function needs an irregular rhythm, or an uncontrollable ventricular tachycardia, before it starts giving shocks. ( Presumably the 70 bpm lower setting refers to the built-in PM function of your ICD )

Are you saying that you were about to develop an irregular rhythm, and if so, how did you know , or did the Holter show that you were close to being shocked ???

Ian

Well

by Grateful Heart - 2014-05-18 10:05:54

I never wore a holter monitor before but assumed they were accurate.

It was my understanding if you're paced at 70 it shouldn't go much below. 57 seemed much below.

I don't know how long it lasted. I was too busy staring at the 57 thinking how can that be. Of all the possible numbers... that one threw me because my normal HR used to be 57 many years ago before the ICD.

After an exercise class (similar to Body Combat) my HR monitor recorded a high of 220. When my device was interrogated it showed 8 events all during that hour with the highest being 217. My defib is set to shock at 220.

Thanks for the responses. I was looking for other experiences and answers. I should have known Inga had both. Thanks again.

Grateful Heart

This is good Marie

by Grateful Heart - 2014-05-18 11:05:18

This is how we learn. That was my understanding too...give or take a few beats. I've seen mine at 68 or 69 sometimes but not lower than that.

I think what Inga is saying (and Inga correct me if I'm wrong) is if I had a PVC while wearing the holter monitor it would throw off the number of beats . It takes a bit for the heart to kind of "restart" the count of beats again. It probably happens more often than not but I only know it now because of the holter monitor.

I do only wear my HR monitor during exercise.

I believe I am set at 14 seconds to shock if I reach 220, I know it wouldn't be immediate but still. My 217 event was 8 seconds.

As far as keeping my HR around 150, it was my understanding I should keep it about 10 below my Upper Limit to avoid the 2:1 block I was experiencing on the elliptical. My UL was raised to 165 about a month ago so I thought 150 would be safe.

I can't take that class again, it also affected my bum hip and it took weeks to recover. I know that's a separate issue but even without that, it was just too close for comfort.

I'm not over worrying but I also don't want to do something irresponsible and be shocked if it could be prevented.

I always appreciate your help Inga and if you have anything else to add, please let me know.

Grateful Heart

Relax

by golden_snitch - 2014-05-18 11:05:47

I read some of your other messages, and I'm thinking that you are doing too much worrying based on what monitors or reports show, and not on how you feel. For example, when you posted about being almost shocked, you said that you just cannot do this kind of exercise anymore and that you have to keep your heart rate below 150 or so. Why? Your device starts shocking at 220, so stay below 220, and not 150! Also, the device can be programmed to deliver ATP therapies before it starts shocking. It does not need to shock you right away as soon as you reach the 220. And now you are saying you want to stop exercising, just because of a heart rate of 57 seen once on a monitor. It's really a bit of an overreaction. Relax :-)

A compensatory pause after a PVC can always lead to lower rates than the programmed base rate. It's a period in which the heart, even if stimulated, will not react. The cells are in a refractory period, and they cannot contract again during that time. So, they don't react to the atrial stimulus directly following the PVC, but to the one after that. That can easily lead to a pause of a second or a little more.

If I were you, I'd not wear the heart rate monitor, unless you are exercising. Keep in mind: What's important is how you feel, and not what the monitor shows.

Best wishes

Inga

Did you ask the Cardio.....

by donr - 2014-05-18 12:05:36

.....about why the Holter measured 57 & you're paced at 70?

What did he say?

Further - how long did it last?

Didn't you say you found the manual for your ICD? Have you looked in it for a potential reason?

Donr

2:1 block?

by golden_snitch - 2014-05-19 02:05:38

Grateful Heart, I didn't know that you had a heart block. Normally, a pacemaker Wenckebach behaviour (2:1 block) can only have an effect, if you have a heart block. With a fully functioning AV-node, even if the pacer stops tracking, the ventricles will still follow the atria's pace. Since you were reaching heart rates way above your upper tracking rate (for instance the 217 the report shows), it does not sound like you have a heart block. And it also sounds like your SSS is probably only at rest. The upper limit or tracking rate is usually only of interest to those who have a heart block, and those who have chronotopic incompetence, and therefore have the rate response switched on.

So, don't know what happened on the elliptical. But it's rather unlikely that this was a 2:1 pacemaker block because you reached the upper rate limit. If this had been the cause, it would have happened again during those episodes around 200, too. Could have been a "real", but intermittent second degree heart block. But then that should not have been tied to your upper rate limit.

Again, regarding the 57, probably just a holter artefact or a PVC. I'd guess a holter artefact. Did you just get the software analysis of the holter? If so, that is often wrong according to my experience. My cardio goes through all holter recordings of pacemaker patients manually, because the software produces lots of non-sense.

Anyways, I'm sure you'll find some exercises you can do without getting your heart rate up too high.

Best wishes
Inga

Rate Response is on

by Grateful Heart - 2014-05-19 03:05:32

When my upper limit was set at 130, my HR would go to 170 or 180-ish on the elliptical and then cut right in half leaving me short of breath and legs of lead. It didn't feel good and I would have to stop the exercise. I tried it numerous times.

Electric Frank (RIP) said to keep it about 10 beats under the upper limit. So my EP raised it to 150 at that time. It still happened so I rarely use the elliptical anymore.

As far as the analysis, I think it was software. All test results seem to be computerized now, EKG, etc. so the Doctor showed me on the monitor what appeared to be EKG strips of my HR during the 24 hr. monitoring.

I do go by how I feel and I feel well.

Don: My Cardio said he would look into it with the holter people but he didn't seemed concerned. Software?? I dunno. I didn't think to ask how long it lasted.

Sometimes it seems the more answers you have, the more questions you have. All part of learning right? I'll find out more when I return in 3 months.

Thanks again.

Grateful Heart

Holters

by PacerRep - 2014-05-22 02:05:05

I didn't read all of the comments so I apologize if I am echoing somebody much smarter than I.

Holters are surface EKG's and can often time "miss" heart beats. Now if you have an ekg printout that is clearly showing a sustained heart rate of 57 then that could be a different issue. The other thing is that you may have a "rest rate" or "night rate". Many times, especially when your base rate is 70, we will set it a little lower at night while you sleep so that your not laying there in bed with your heart going too fast. What time did this 57bpm occur?

for the fast heart rates, your ICD should have recorded those as well, did it confirm the 200+ beats per minute? I'm a little confused why they gave you a holter in the first place since a device is essentially the same thing, only better. Unless you only have 1 lead in the ventricle with no atrial picture?

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