Interested in hearing f other competitive cyclists


I had my PM inserted 4 months ago, and I am trying to learn as much as I can about what is happening with the device and my body during exercise (so please forgive my simplicity in describing my case) My PM was placed under an emergency situation, so I never had a chance to research what kind of device I should have. The cardiologist did know I was an athlete so hopefully a suitable one was chosen.( I have a St Jude duo lead) I was in sinus arrest (with 8 second lapses), and was also told it was a heart block. I have been back several times to be tweaked, but I still don't feel like things are where they should be. The RR is on, and set rather aggressively, and initially I felt that was necessary for cycling since there is no arm action with cycling. I didn't feel like my heart rate was increasing as it should with exertion, especially when climbing hills. I seem to max out at about 140 bpm, which was the case before PM insertion. There are times now (as there were before PM insertion) where I may try to exert and there is "nothing there".......my legs are dead and I just can't go. My PM is only set to not go below 60 bpm. At one of my interrogations, I was told that my SA node does work on its own with exercise. This is all so confusing! I appreciate any input or thoughts and suggestions on what kind of questions I need to bring up to get this device set correctly. I live in a rural area and I really don't think the clinic has many (if any) endurance athletes so they probably don't really know what to do with me.

9 Comments

Rate response

by golden_snitch - 2013-02-20 03:02:30

Hi!

You're probably one of those patients who would have benefitted from getting a pacer with a dual sensor rate response. There are pacers out there with accelerometer and minute ventilation sensor, so that missing upper body movement is not such a great problem, because the minute ventilation sensor will sense that you are exercising. I can compare, because I have had both, the dual sensor and the accelerometer only, and dual sensor really makes a difference. I'm on accelerometer only now due to problems with the leads (I have epicardial leads, and the minute ventilation sensor doesn't work with those), and I can hardly bike at all, because the RR just doesn't respond appropriately.

However, if your sinus node does work when you are exercising, then you might not need the rate response that much. What's important is that you get the upper rate limit programmed high enough, so that in case of heart block, the ventricular lead keeps tracking the sinus rhythm, and doesn't stop at 140bpm or so. What's your upper rate limit/tracking rate?

Best

Inga

Thanks so much!

by Sherriluvstobike - 2013-02-20 03:02:44

I am so grateful that you all took the time out of your busy days to enlighten me. I now have some "tools" to investigate so I can get where I need to be. Inga, I asked about the "upper limit set" and was told there was no ceiling, if I understood them correctly. Or as RunBikePacer said, " I've been told the PM does nothing to keep your HR below the upper limit set on it. At that upper limit is just stops pacing your heart." I do have a St Jude's device so will request to have a rep present while I'm on the treadmill. And yes, of course I am very grateful to be alive. Check out my story at

https://www.susquehannahealth.org/heart-and-vascular/our-stories/sherri-s-story/page.aspx?id=5030



But I want to be certain that I have explored ALL of the possibilities of why I might be feeling sub-optimal during exercise. Then I will accept my limitations d/t the situation and age (but I'm only 52yrs old!). Once again, I am grateful for this site and all of your contributions. I will keep you posted.

Tweaked

by grasshopergp - 2013-02-20 04:02:38

What is Tweaked?
Got mine Jan. 23rd-

Tweaked....................

by Tattoo Man - 2013-02-20 04:02:54


.....................Jan...for a Brit I am not going down the fun route.

'Tweaking' is a bit of a Brit expression..........it means how the Techie adjusts PM settings to maximise the individual 'hosts' needs.

Being 'tweaked' is the very thing that you should insist on when you see your PM Tecchie.

Key, is telling just how you FEEL..Mr Tecchie wants the best for you.

Best wishes

Tattoo Man

Tweaked is...

by Sherriluvstobike - 2013-02-20 04:02:56

Hi Grasshopergp, "tweaked" is basically slang for having the settings in your device adjusted, to better fit your lifestyle or activity. It seems to be more of a challenge when we are athletes.....

Fellow Cyclist

by Wayneflewis - 2013-02-20 04:02:58

see my post " Back in the Saddle"

I had my dual system fitted for agressive bradycardia one month ago. I am now half way thru my second week. So far so good. My low setting is 50 bpm and my hight is 160bpm. ( I am 61 years old and have been a competive cyclist since my teens) So far I am not pushing it and have not exceeded 152 bpm and typically (according to my Garmin 810 ) average around 118-125 bpm over a two hour ride. I have had a couple of rides that I have felt down on energy but think that it may relate to getting my full fitness back after 3 and a bit weeks off the bike.
I am not sure if this is helpfull but its my belief that steady determination to slowly ramp up the levels while keeping a really positive attitude. Hard I know but try to talk to any cyclists that have been in your situation. Happy to to chat via the private message system here.
I wish you the very best.
And as my t-shirt says...keep calm...ride a bike.

Trial and error !

by IAN MC - 2013-02-20 05:02:54

There seems to be some uncertainty whether or not your sinus node is working to its full capacity or not. The only way to find out is :-

i) Have RR switched off and see how you feel

ii ) If this doesn't work ,have it switched it back on with a less aggressive setting and see how you feel

iii) try adjustments to the upper rate limit and see how you feel.

It would be great if some guru could sit at a machine and say " these are definitely the optimum settings for you" but
only the way you feel when you exercise can determine the right settings . Living in a rural area may make it difficult to have repeated visits for PM adjustments.

Are you able to fix up a longer appt , get wired up to a treadmill and exercise with various settings rather than have to make repeated visits

Also, in my humble opinion, as a runner rather than a cyclist, there is a danger that we automatically blame the PM rather than the loss of our training fitness which periods of inactivity soon produces.

Best of luck

Ian

Bike / Run..................

by Tattoo Man - 2013-02-20 06:02:01


................................all the above is sound. As a one-time club time trialler (22.27 for a 10) I really understand the question of performance drop off and have come to the conclusion that it comes down to some basic facts :

Settings..as IAN said ..keep on getting adjustments

Rate Response..mine is now 'off'..last night I ran and went through a kind of ceiling of 160 and got to 178 with a 123 average from resting. I had to hammer myself for the 178 but never even gasped on stopping.

As others have said, fitness drop-off is alarming beyond a certain age,..you have to get your ass out there and give it some serious work to do.

Post PM I think we all see things differently and maybe some 'fire' goes with being, thankfully alive.

There was something wrong with your heart, so be grateful for what you CAN do

This is an evergreen question...how come PMC doesnt have a resident Cardio / Tecchie to answer these kind of questions ?

Tattoo Man

athletes

by Tracey_E - 2013-02-20 09:02:09

Most clinics don't deal with many athletes, their average patient has a list of other health problems and is mostly sedentary. Is someone from the drs office doing your programming or St Judes? If it's not St Judes, ask to see one of their reps. They deal with a wider variety of patients and they have access to case studies. Once my rep was stumped and unable to find a case study with a situation similar to mine, so he faxed all my records to St Judes. The engineers that developed my pm looked at my records and came back a few days later with recommended settings. St Judes rocks.

Two things jump out at me. If your sinus node responds normally with exercise, try it with RR off. RR steps in with sinus dysfunction so it may be competing with your natural sinus rhythm, esp if it's on an aggressive setting.

Also, if you are not getting over 140 and you are in block, your atria may be going higher than 140 but the pm is only pacing the ventricles up to 140. When that happens, you get the symptoms you described. BTDT :) Ask them what your upper limit is. They usually don't set them much over 140 but they can go as high as 180.

One last thought, trial and error can get old! They like to make the changes in small increments, which makes sense, but it's frustrating when you should be able to work out but can't. I've had really good luck getting on the treadmill in the drs office while hooked to the pm computer. They can watch and make adjustments then try them out immediately.

You know you're wired when...

Microwave ovens make you spark.

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My cardiologist is brilliant and after lots of trial and error got me running. I finished this years London Marathon in 3hrs 38 minutes.