Question

Hello all,

I was wondering if anyone can shed some light on some recent changes I've had on my pacemaker.

My upper rate limit no longer has a upper rate, it has been removed. it was set at 180bpm.

At the same visit, when my upper rate limit was removed, my PVARP then was programmed to 250ms from 270ms.

I have a Medtronic Adapta - Mode Setting is DD1.

Can anyone shed some light on why this change took place, I'm trying to avoid any unnecessary pacing. Would the recent PVARP changes ensure any unnecessary pacing.

I'm reading the Medronic manual and I don't see anything that can answer this question for me, if anyone know, I'd appreciate your input.

Thanks as always,

Moner
>^..^<

4 Comments

H Moner

by IAN MC - 2013-11-04 03:11:27

I look forward to an informed reply on this. It seems to me that there is much confusion re upper rate limits and the difference between Upper Tracking Rates and Upper Sensor Rates.

I assume that you don't have Rate Response on, from your Mode setting , in which case the Upper Sensor Rate has no effect . When RR is Off the upper sensor rate has no purpose, as it's function, seems to me, to be to determine the maximum level at which the RR sensor drives pacing.

Is it your Upper Sensor Rate which is no longer listed ?

The Upper Tracking Rate, as I understand it, is to put a limit on the sensed atrial rate which is passed on to the ventricles. Its main purpose seems to be to prevent an a fib from confusing the ventricles into fast pacing. Sometimes it is on when no atrial problem exists. I think it is the Upper Tracking Rate which is set according to your age and preconceptions of what your maximum HR should be .

The more I write, the more confused I am becoming... Pacer rep where are you ?

Best of luck

Ian

Ian

by Moner - 2013-11-04 03:11:35

Hi Ian,

Thanks for stepping in, I don't have a Rate Response, not a Rate Drop Response set on my pacemaker, never had.

The more I read, the more confused I get sometimes, just when I think I understand something, something else gets added to the equation.

From what I understand from my EP my Upper Sensor Rate is set at 180bmp, only for tracking purposes, he said that if he lowered the rate it would use up a lot of space and battery usage. Since I run a lot of 1/2 marathons he knew my heart rate easily reaches those rates without any consequences.

I know exactly what you are refering to when it comes to setting the upper rate limit, that is a general formula for the average Joe. From the posts I've read about you, you are very active and I don't think that general formula applies to people like you.

I think sometime I just have to walk away from it all and digest things bit by bit.

Thanks for your interest.

Moner
>^..^<

PVARP

by lbdina - 2013-11-04 03:11:47

Moner, I have been reading a book called Nuts & Bolts of Cardiac Pacing. Adjusting the TARP and PVARP values, along with maximum tracking rate, can help control at what heart rate multiblock and Wenckeback occur. If you run a lot, you wouldn't want multiblock to occur, as this would suddenly cut your heart rate in half when you exceed the max tracking rate. Not so good for running! These settings can delay the onset of multiblock and trigger Wenckeback behavior between MTR and Multiblock. According to the book, lowering PVARP is one part of this equation. Not sure if that is the reasoning behind the change.

Thanks

by Moner - 2013-11-04 09:11:31

Hi Ibdina,

Thanks for your input.

I no longer have a URL, so hopefully I will not have any forced Wenckeback behavior.

Your last sentence has helped me out.

Thank you,

Moner >^..^<

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