Upper Rate Settings

Hello Friend in Pacemaker Land,

I'm coming up to my 10 month anniversary for my pacemaker and was wondering if I should request my upper rate setting be adjusted higher.

I'm a very active person and will be running in the NYC marathon in November.

I'm not pacemaker dependenet.

Right now the upper rate is set at 150, my real question is....
What are the DISadvantages if I go higher.

If anyone know, I'd appreciate your input.

Moner
>^..^<

8 Comments

I disagree with that one

by ElectricFrank - 2012-09-09 02:09:04

The Wenkebach from Upper Tracking Limit starts at a time when the person is engaged in a high aerobic activity, and reduces both cardiac output at a time when it is needed. I realize that common wisdom is that it is no big deal, but a bit of hydrolyic engineering analysis would indicate otherwise.

Unless the person is experiencing high rate atrial events that need to be limited in their effect on ventricle pacing, there is no reason to limit tracking especially in electrical block. I'm 82 and have my upper limit set to 150 just to keep it out of the way. I monitor my HR during high activity and keep it down in the 130 range with the advantage that a bit of overshoot during cool down doesn't hit me with Wenkebach. I've been paced with that limit since 2004 with absolutely no indication of problems.

That type of limiting is like causing an engine to start missing on half its cylinders as a governor.

frank

How old are you

by PacerRep - 2012-09-09 02:09:47

I posted this somewhere else but it applies here too

Upper Rate Response setting 101:

You take your the #220. Subtract your age. Then multiply it by 80% (or .8).

Example. A 70 year old healthy person....key word healthy.

220-70 = 150
150X.8= 120

In a healthy 70 year old patient Upper Rate Response should be set at 120bpm.

There is always exceptions to the rule, An innactive 70 year old vs. a 70 year old still running 5K's you could cheat a little bit for the latter patient.

Your device will have a ceiling on Upper Rate Response as well, Some pacemakers only go to 150, others go as high as 185.

Hope this helps

Thank YOu

by Moner - 2012-09-09 02:09:51

Thanks everyone for weighing in on my question.

I agree with you especially Frank regarding the upper rate limit.

It prefer to have my heart reach whatever limit it needs without any kind of interference from a Wenkebach setting.

I'm looking forward to my next visit with my EP, I will request this adjustment.

Many thanks everyone.

Moner

asfasfasfa

by boxxed - 2012-09-09 03:09:12

The only, only consideration I can think of off the top of my head to not going high upper rate is having a long retrograde conduction and symptomatic PMT. Upper Rate and PVARP go hand in hand. So the higher your upper rate, the less the possible length of PVARP. If you have a long retrograde conduction, you may experience not have a PVARP long enough to cover the retrograde event and subsequent PMT may ensue which you may or may not be symptomatic to.

But PMT isn't really a big deal in the big picture. I wouldn't consider it close to lethal. Moreso uncomfortable than anything, if it's noticed at all. And there's always the chance you don't have retrograde conduction. 2/3 of people have it and situations where you have to make a serious tradeoff between Upper Rate vs. PMT are pretty rare.

In my own humble experience

Wenkebach

by PacerRep - 2012-09-09 05:09:25

You may have Wenkebach but its usually not that big of a deal. I wouldn't worry about that. It's more can your cardiovascular system handle those upper rates. If your running marathons the chances are that it can. Even at those extreme upper rates past 140. The pacemaker has to see some serious activity for it to pace up that high, so even if you set it that high, you may not ever see that rate.

Thanks

by Moner - 2012-09-09 05:09:42

Thank you PaceRep, I'm 46 years old that puts me roughly around 140 bpm.

I will be heading to my EP's office on Sept 25th and I'm thinking about asking him to raise it, I'm concerned that if I exceed 150 bpm, there may be some kind of Wenckerbach setting (that I'm not aware of) that would force my heart to skip a beat, so I do not exceed my present upper rate.

I've been training for this marathon since May and I don't want any complication in November.

Thanks to your response.

Moner
>^..^<



raising it

by Tracey_E - 2012-09-09 10:09:29

If you are maxing out when you run, then it should be higher. If you are not hitting the upper limit and feel good, I'd leave it alone. It's pretty easy to tell when you hit the top limit when exercising! Also, the pm records it so they can tell when they check. My upper limit has been adjusted up and down a handful of times over the years. My doc set my current upper limit (180, the highest my pm goes) by watching me run on the treadmill in his office. I get up to 160-170 and feel good, so 180 gives me a cushion over my usual highest hr.

I'm 45 with CCHB, btw, but my rate while exercising has always been all over the place so we go by the treadmill and how I feel rather than the formula. For years I was fine at 140, then my rate started creeping up. When I started hitting 190 regularly and felt awful, he put me on beta blockers rather than give me a pm that goes higher when I had my last replacement. I don't need to be going 190 :) Long way of saying, there is no one right answer. If I can do what I want and feel good, whatever setting I'm on is the right one for now. When I struggle, they put me back on the treadmill to see what's going on and adjust accordingly.

PacerRep, does it affect battery life if it's set higher than we need it?

Now I want my upper rate limit adjusted!

by asully - 2020-06-20 01:04:15

I did not know they could raise it more, I have a Medtronic from 2016.  I have explained to them numerous times that I can't "go" because I hit the limit.  Mine is set at 140 last I asked, and they gave me the impression I couldn't go higher.  Using the calculation my number is 149.6.  I had a treadmill stress test today, couldn't finish the test cuz I hit my limit and they kept trying to get it higher haha and eventually I couldn't compensate for the increases, not enough juice! They wanted me to hit 90-95 percent a age max rate max at least which would have been at least 168.3.  You think they would have known I wouldn't be able to get that high?

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