Increased heart rate

Hi,

I just had a Biotronik Evia DR-T pm installed about 2 weeks ago, I'm a 48 year old male and was running 1/2 marathons prior to this. I had it installed to prevent Syncope, I had my first episode about 1 month ago, then 2 weeks ago while performing a stress test I got off the treadmill and felt light headed and was out for 30 seconds. When I came to within about 4 minutes, the head of cardiology mentioned that I should have a pace maker installed, what a shock this was!
Anyway, I had it installed that same day and was released the next day. I have no pain and everything appears to have went smoothly. Here are a few things I'm noticing though and wanted to find out if other people could make some suggestions:
I noticed that in the 3-4 days after having the pm installed that my heart rate would increase with very little movement and sometimes while just sitting in bed. I would get out of bed and walk to the bathroom and back and immediately need to sit down and relax in order to the hr back down (my resting hr prior to this was in the low 50's, now it seems to fluctuate between 60-70's). I stayed in bed about 6 days as I did not want to have to go thru heart rate increase episode.
I went in 1 week after and met with the Biotronic rep and he turned something called auto-capture off and this seemed to help some. He also indicated that I was sensitive to ventricular pacing as when he was running a test where the ventricle rate increased it caused my to feel really, really bad! But no other adjustments were made at that time. They recomended that I try and more around more.
So since then I have also been slowly walking around and while it has improved if I walk for more than a couple of minutes or I walk up my stairs too quickly my hear rate goes up into the 90's (this is high for me) and I have to sit down right away and take deep breaths in orde to get it lower. This is not right.
So my big question is, are there some pm settings that need to be changed in order for me to be able to move around better so as to not get my heart rate up as high as it is currently going after a small amount of excertion? Please be very specific or let me know if you need more info as I have an appointment with the device clinic in 2 days and they can make the necessary adjustments.
This has all happended way to fast for me, I just want to get back to feeling normal again.

Thanks,
-Les

6 Comments

settings

by Tracey_E - 2012-12-10 08:12:56

The first thing to know is this is perfectly normal!!!! They like to make the adjustments in small increments so it can take a few tries to get it right. They usually send us home with settings for the average patient, who is considerably more sedentary than many of us here.

First, do you know exactly why you had the syncope? Was your heart stopping or dropping? If your rate dropped, do you know if it was from the atria or ventricles? It's two entirely different fixes.

When your rate jumps up quickly that is more than likely rate response. RR physically senses movement and raises your rate for you. If your problems come from the ventricles, you probably don't even need this turned on, and it's possible having it on is causing the problems because it competes with your natural hr. In my case, my atrial rate is normal but I have an av block so the signal doesn't make it to the ventricles. I have RR turned off because my rate doesn't need help to go up, only to make sure the ventricles keep up with the atria.

Now, if you do need help keeping your rate up and therefore need rr on, instead of turning if off you want them to adjust the sensitivity settings. It can take a few tries to find the balance between going up when you need it and not skyrocketing every time you sneeze.

They can also adjust the settings for how quickly the pm kicks in with ventricular pacing, how much time the heart is given to beat on its own after the atria beats. Sometimes it's set to jump in too quickly so a bit more of a delay helps you feel better.

And there are a lot of other settings! Something that has helped me a lot is getting on the treadmill in the office while on the pm computer so they can watch what happens for themselves.

One last thought, if 90 was high for you before it may not be now that your heart is beating normally. My hr was never over 44 until the day I got my first pm (congenital problem). My pulse was 44, but my atrial rate was considerably higher than that, the signal never made it to the ventricles so my pulse stayed low. Now it never goes under 60 and when I work out it stays around 150. It felt REALLY fast the first few months, it took some getting used to. What I was used to was abnormal, so "normal" felt abnormally fast, like I'd overdosed on several pots of coffee. Also, my heart was extra sensitive and shot up quickly for a while. It took some time for it to level out and get used to beating in sync.

Have faith! It's still early days and what you're going through is common. There is a fix, just know that it may take a few tries.

Thanks

by ltcoop - 2012-12-11 02:12:25

Thank you very much Tracey and Laura !!!
It helps me to know that what I'm experiencing can be fixed, I was originally under the impression that this would be something that I would have to deal with on my own, but after some research and your comments this reassurs me that by changing some pm settings will make it better.
When I had the 2 episodes my heart had stopped beating, the first time it happened I was warming up to play ultimate frisbee and it happened shortly after I had stopped running, I guess I was lucky that the second episode occured at the hospital !
I think the problem I'm experiencing with the increased rate has something to do with my sensitivity to the ventricular pacing, so would turning off the rate response resolve this?
If I recall correctly they indicated that I was paced about 50% in the atria and 1% in the ventricle, although the syncope was not caused by the issue with the atria (I think this is what they told me).

Thanks again,
-Les

pacing

by Tracey_E - 2012-12-11 04:12:23

I'm not sure what they mean by sensitivity to ventricular pacing. You're not really even pacing ventricle. Ventricular pacing is different from atrial. With atrial, the pm is trying to mimic what your heart should be doing if it wasn't wonky. With the ventricle, all it's doing is watching to see when the atria beats, gives the ventricle a fraction of a second to follow the atria, then kicks in with pacing if it doesn't. If they manually turned up the ventricular pacing during a test, I would expect it to feel bad. I often feel like I'm on an elevator when they run their tests, that up/down feeling when the elevator comes to a stop. They turn it up, they turn it down, it feels weird.

Atrial pacing is two parts. One, it makes sure your hr never plummets/stops which is what it sounds like happened when you passed out. It has a minimum rate setting, usually around 60 or 70. If your heart drops below that, it kicks in and adds beats. The other thing it does is make sure your rate goes up appropriately with exercise, that's rate response, you may or may not need that.

I am not a medical professional but if you have times where your rate is too high without activity/minimal activity, you are being paced too much. Sounds like you probably need RR on but it's too sensitive, turn it down to give your heart a chance to go up on its own when you are active. Or possibly the lower rate is too high. If it's set to 70, ask them to let you see how you feel at 60. Worst case it doesn't feel better and they turn it back up.

Good luck getting it figured out!!

I agree

by ohiolaura - 2012-12-11 08:12:56

Im new here,but what Tracey said sounds like what alot of members have told me when I was having issues in the beginning.
I had adjusting that had to be made too,took me 10 days to figure that out,in the ER.I believe they turned of the RR,as Tracey said,as I have what she described,ventricular problems.It made a huge difference.I had been working out prior to surgery,but after it kicked my butt,took awhile to get back into it,but I have.
Call your Dr,get someone to check your device,you should and will feel better.
Laura

Turned Rate Response Off

by ltcoop - 2012-12-13 01:12:40

Hi Tracey,

You were correct !!! It was the rate response.
They turned it off and my heart rate no longer increases to 90 within a few minutes of walking. I guess my pm has 2 levels of RR, it has an accelerometer for motion and it has something called CLS for emotional rate response. They turned them off completly as my heart is able to pace on it's own (I also found out that I'm classified as having SSS). The pace maker was improving my heart beat as they showed me on an EKG printout where it was filling in for some abormalality on the upward spike (sorry I need to find out the medical term for this, I've had too many things to learn in a short time), but with the RR turned off it was no longer helping out with this, they said that the was acceptable and that if I did need the RR later they can turn it back on and adjust it as you had mentioned.
One thing I wanted to mention is that I think this would have been resolved sooner than this, but the tech from Biotronik was not really helpful he seemed more concerned with keeping the settings at the default settings and he actually asked my why I was reacting the way I did the second time he ran the diagnostic that increased my ventricle rate and made me feel so bad.
He is just one of those people that are not sensitive to the needs of others, it's too bad there are people in such a position, where if they really cared about other peoples needs/feelings things would go much more smoothly. On the flip side the tech that works for the hospital was really helpful. He was the one that pushed to have the RR turned off, and he seemed concerned with getting me back to feeling normal.
I think it helps to have the right people helping us when we are going through such a life altering process such as having a pace maker.
Also I want to Thank you again Tracey, you really helped me alot, it can be a scary process and you and the other members that help us newbies out really deserve a lot of praise in sharing your knowledge and giving us hope that things will get better.

-Les

Increased rate on occasion

by ltcoop - 2013-03-06 04:03:20

Hi again,

Trying to get some ideas on why my heart rate would suddenly shoot up from about 50 bpm to 80 bpm or more (these are only approximate numbers). I have both rate response and CLS turned off. Everything was fine for the first 2 months (after turning off RR and CLS), then on the third month I've had 3 of these episodes. Each time it happend while sitting at my desk at work while concentrating on the computer screen. I first felt an irregular heart beat as if it skipped a beat and then the rate goes up suddenly, it is the same sensation as when the rate response was turned on, where I feel like I need to relax and take deep breaths in order to get my rate to come back down. It does this for about 10-15 seconds, I know it's not that long, but it makes me feel uneasy/stressed out afterwards.
If anyone has any ideas about any pm setting that would cause this please let me know.
I'm meeting with the cardiologist in a few days to go over this, but it helps to have some ideas ahead of time.
During my 3 month pm check they said everything looked great, and I mentioned the episodes, but they were not able to see them looking at the pace maker data, the pm did not register any dangerous events. I asked if there were any settings that would cause this problem, but they were not aware of any, but I still suspect that some setting or settings could be causing this. They also indicated that I was paced 19% on the atria and 0% on the ventricle.

My pm lower rate is set at 50. I'm not exactly sure when the episodes happened if it was going below 50 as my normal resting rate is in the 50-60 range. I wonder if my pm lower rate needs to be set to a lower value?

Just for reference I have a Biotronik Evia DR-T installed for syncope which occurred after excercise.

Thanks,
-Les

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A properly implanted and adjusted pacemaker will not even be noticeable after you get over the surgery.