Medtronic revo issue

I had a Ross Procedure done in August of last year. It's a double heart valve replacement. A complication arose resulting in full heart block and the need for a pm. My husband and I had to decide quickly and we went with the Revo because it was MRI compatible and wouldn't have any effect on my lifestyle according to the EP we consulted with in the hospital. I'm 47 and physically active. During cardio rehab, my heart rate would get to 130-150 and then drop to 69-72. I saw a different EP who tells me there was a limit of 160 on that model, preventing me from much exercising. Needless to say, I was rather annoyed at the EP in the hospital that led me to believe otherwise. Now I need to replace the revo. I'm looking or some advice on devices that allow high intensity workouts with higher heart rates.

2 Comments

A better PM ?

by IAN MC - 2013-06-01 07:06:03

I have a Medtronic Advisa which is MRI compatible and has a maximum tracking rate of 210 bpm. It advertises as being " ideal for young active patients "

The Rate Response feature is only triggered by body movement though; I think there are other makes of PM where RR is initiated by breathing rate as well as body movement i would be interested to hear from anyone who has one of these other models

Ian

models

by Tracey_E - 2013-06-02 02:06:32

You happen to have what I'm pretty sure is the only pm on the market that doesn't do at least 180! I don't know why they are using that one on younger active patients. There is at least one other person here with the same problem. Medtronic has one that goes to 220, but 180 is the standard.

If you have primarily heart block, you most likely pace ventricle only and may not need rate response which is for atrial pacing. Upper tracking limit is the most important thing with a pm for av block so don't get caught up learning all about RR.

I wouldn't be in a big rush to change it out, however, there is something else you can try first. The sudden drops are the pm which means they should be able to program it not to do that. What's probably happening when your rate drops like that is the pm senses an atrial rate higher than your upper limit (150 or 160), it thinks you are in afib so it puts you in an artificial 2:1 block and your rate suddenly drops in half because it's only pacing every other atrial beat. It's a safety feature that's great if you are in afib, annoying if you are just trying to exercise.

When this happened to me, they turned off the safety feature so no more sudden drops. Sometimes I drop on my own, so they turned on rate drop response. Now if my rate suddenly drops on its own, the pm kicks and paces to keep my rate level. Between the two, I am able to do pretty much anything I want. If I feel funny working out and count my pulse it's usually right at 160 which means my atria is probably going faster than that, it does not feel good when the heart gets out of sync. I break for a minute and do slow deep breaths to bring it down, then get back to it. It's not ideal, but I don't consider it more than a minor annoyance.

I considered the one that does 220 on my last battery change (I'm on #4) but decided to stick with what I have because I adore my St Judes rep who's been with me since my first one, and I talked it over with my dr and decided that I really shouldn't be getting up over 200 when I work out anyway.

Insurance may not pay for a new pm when the battery is good and it's functioning. They aren't going to consider wanting to work out harder a medical necessity. Regardless, I'd exhaust all options with the programming before having another surgery.

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