I am still around...

I am still hear lurking, not much posting. I am still in the fine tuning stages and the DRs are getting ready to throw me on a treadmill. I am doing great, but things aren't quite perfect like I would expect.

So, I learned today that there is another factor in how high a pacer can take you. I thought the upper tracking rate was it..., now they tell me the sensing rate is the magic number. Can anyone tell me the difference? My UTR is 200, my sensing rate is 130 or 140...I don't get it!

Anyway, every visit seems to get better.

13 Comments

Rate response

by golden_snitch - 2013-03-05 04:03:42

Frank explained it very well.
If they tell you that the sensing rate is the magic number, it sounds like your rate response is switched on. In your profile you say that you have exercise-induced heart block. Hmmm, heart block patients usually don't need the rate response turned on. With a healthy sinus node, all your pacer needs to do is track the sinus node's rate. So, not sure what your doctors are doing. Also, this huge difference between tracking rate and sensing rate does not really make much sense to me. If you do need the rate response, then why don't they give you more than 130 or 140bpm?

Inga

Thanks all! And another question..

by USMC-Pacer - 2013-03-05 08:03:51

They DO have DDDR on. Is there any medical documentation that I can show the nurse that I shouldn't need the Rate Response?

She is currently scheduling me for a treadmill test to see what is going on.

Although I am doing much better - I am up to 2 miles in jogging, but it seems that I am working harder than I should be... almost like the Rate Response is over reacting. She lowered the sensitivity of it yesterday, but it made no difference. I have to call her back tomorrow with the bad news.

Don't get me wrong, I could get by with these settings, but I just don't think they are quite right.

So, if anyone has any medical documentation that I could show them, maybe they would listen.


Thanks again!

What happens if upper rate exceeded?

by ma_ku - 2013-03-05 10:03:38

Hi,

I had my PM implanted 2 weeks ago. They set the lower/upper limit at 50/150 respectively. The mode is set to AAIDDD.

I have AV Node 2nd degree (Mobitz 2 type) heart block.

Now I have been building up my exercise the last few days and today I comfortably got my heart rate up to 180 (according to my heart rate monitor watch). I had a really good session actually on the stationary bike and felt great during and afterwards.

It was my understanding that if my heart exceeded 150, the PM just wouldn't do anything. It would monitor only. I am confused about upper limit though. Is it the case that the PM just stops pacing above this rate, or is it supposed to bring you back down to 150? It certainly didn't feel like the latter (thankfully).

Mark

It's a big learning curve

by ma_ku - 2013-03-05 12:03:00

snitch,

Thank you for your explanation. I think I understand it a bit better now.

Mark

Upper rate limit

by golden_snitch - 2013-03-05 12:03:00

Hi!

You are programmed in a mode switch from atrial sensing and pacing only to dual-chamber sensing and pacing in case you go into second degree heart block. The upper rate limit only matters, if you have a heart block while exercising. In that case the ventricular pacemaker lead needs track the sinus node and pace the ventricles at the same rate. Since the limit is 150, it would pace your ventricles at a rate no higher than that. So, yes, it just stops pacing at that rate, and only if there is a heart block. Apparently, since you can bring your heart rate up to 180bpm, you do not have any heart blocks when exercising; at least not last time.

Inga

Good Question - Good Answer

by Casper - 2013-03-05 12:03:24

Thanks Frank for weighing on this question, it was a good one.

Good to hear from you again USMC

Easy

by ElectricFrank - 2013-03-05 12:03:30

The Upper Tracking Rate is the maximum rate at which the pacemaker will pace the ventricles in response to the atrial rate. This usually means the maximum HR that the pacer will allow based upon your natural pacemaker.

The Upper Sensing Rate is part of the Rate Response system and only has an effect if RR is turned on. What you need to know is your pacing mode. With mode-DDD for instance, RR is off. With mode=DDDR it is ON. There are other possible modes and the thing to look for it the last letter of the mode. I will be R if rate response is in use.

frank

A simple way to check

by ElectricFrank - 2013-03-06 01:03:35

Take a continuous ECG recording with RR off (DDD mode) during exercise. The upcoming treadmill would be a good opportunity. With this available all that is needed is to look at the atrial rhythm. If it responds appropriately to exercise it's hard to justify RR.

In my case there was an ECG taken before implant, and I just pointed out that my atrial rate was in the 80's from briskly walking down the hall to the lab. It gradually slowed down during the ECG. Meantime my ventricles were happily doing there own thing at around 35bpm.

It was all there and obvious, but none of the medical types had noticed. The only one who seemed to understand what I was pointing out was the Medtronic rep.So I insisted on having RR turned off. As soon as I got home I did a session on my exercise bike and watched my HR go right on up as it should.

In your case they should be able to do it all during the treadmill test.

The thing that gets to me is that the medical folks get so buried in impressive language that they miss the simple nature of things. From my perspective there is no difference in setting up a pacemaker than there is adjusting synchronization on electronic circuits I work with.

best,

frank

They kicked me up a notch...

by USMC-Pacer - 2013-03-06 07:03:51

I see the EP tomorrow (finally)

I just found out today that all the nurses I have seen for the last few months think I have AFIB... I have never had AFIB! While speaking with the NP, I asked her why they couldn't just turn the RR off and let my healthy sinus do the pacing. She asked about my AFIB???!!! Say what???? When I told her I have never had AFIB, there was a lot paper shuffling and silence. She agreed that I probably shouldn't be using the RR mode. lol

Oh boy, can't wait to see the EP. I'll keep you posted...

Thanks, will do..

by USMC-Pacer - 2013-03-08 06:03:54

I am now on 1:1 pacing w/ no RR to an UTR of 200... yeah!!!

I haven't had a chance to test it out yet, but I feel better all ready if that makes any sense.. be back soon with an update.

Mistaken dianosis

by ElectricFrank - 2013-03-08 12:03:40

I had the same problem with being tagged with SSS, and angina. Even after clearing it up with the cardiologist, and having them removed from my medical records they returned. I checked with the clinic as to whether they wanted me to come in or just do a Carelink, and the nurse said "Oh with your SSS we always need to see you".

My concern is that I would have a medical condition or accident while away from home, and have some ER treat me as though I had those conditions.

In your case you could be necessarily be put on thinners for your AFIB. I would make it clear to them that you want afib removed from any records.

frank

frank

Post exercise observations:

by USMC-Pacer - 2013-03-09 04:03:44

Different, definitely different.

Heart rate much more responsive than before. Went higher faster, and lower faster after I stop. Although I think I am coming down with a cold or something also, so may be a result of the higher rate. The other thing I noticed is the leg fatigue and post exercise leg soreness is gone. I felt stronger overall.

I am pretty sure it is another set of settings I will need to get used to. My body / heart must be wondering what the heck I am doing to it.

Much better today...

by USMC-Pacer - 2013-03-10 08:03:47

Today's run was much better than yesterday. Heart rate is responding much better, I feel stronger, and not limited like I did before. Strange how after runs the past few months, my calves would be sore and cramping. Now, that's gone and all feels great.

Funny how a few settings changes / or the elimination of unnecessary settings really make that big of a difference with everything.

Thanks again everyone!

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