Pacer operation

I have had my Medtronics RVDR01 Revo MRI for 4 months now and I'm a little confused, I think I know how it works but some time I'm not sure. Under normal every day use it seems just fine. But when I'm riding my mountain bike is when I'm not sure. I have bradycardia (and afib which is under control with Multaq) so the lower limit is set at 60bpm and the upper limit is set at 140. I know that at the lower limit the pacer only kicks in when the bpm goes below 60, but what about the upper limit? If I am pushing hard on the bike and my rate goes up will it go past the 140 mark or does the pacer stop it there? I wear a heart monitor when I ride and some times it goes to 155 but I'm not sure if the pacer is interfering with the heart monitor.

I'm also not sure if the pacer is set right for maximum performance. I had it set while on the treadmill and the doc and tech said it was set right, but on my rides when pushing hard I get very short of breath very quickly. Much more than before the pacer. So I'm wondering if any one has some suggestions as to what I might do? is there a different pacer that works better for athletes???

4 Comments

pacer operation

by Jill7 - 2012-12-15 08:12:24

I also have the Medtronics for bradycardia, mine is set for 50 and 150. I haven't had any trouble getting my heartrate that high but last time I had my "pacer appointment" I asked the technician what would happen if I did reach the 150 because I'm pretty actice as well. He said that it would stop your heartrate from going any faster and you would definately feel it. He didn't go into great detail but you can always have the heartrate set to a higher setting. I've only had mine for about 6 months now so I still new at this as well.

Questions to ask

by marysoranno - 2012-12-15 08:12:25

Hi. My name is Mary and I received my device when I was in my 20s so I understand your questions and concerns about participating in athletics. I happen to work for a cardiac device company (I know strange) so i can give you a bit of information. First, I'm assuming you have a dual chamber device since you said you had bredycardia. Has the doctor said you are chronotropically incompetent? If so, is your device set DDDR? Second, is you AF persistent? These two questions are key to understanding what could be going on. I have initial thoughts but can give you better Info once these questions are answered. Good luck.

Pacer operation

by sugar - 2012-12-15 09:12:22

I have a Medtronics dual line. I am set at 60 on the top and 67 in the lower chamber. At night I was adjusted into a sleep mode of 55/67 which I will change after many objections from the medical staff I see. Note that none of them will probably not have had to live on one of these things. They only go by their written data and I have found that each experience is a little different from the next person. Me and their written knowledge don't get along because for me mine is paced too fast and it is like I am on speed. I like the more mellow and relaxing space within myself. Before the pacer I was clocked in at 240 bum for over 3 hrs so I know what Afib can do and I have been clocked as low as 35 bpm. Bradycardia, yes, sick sinus, yes, deformed heart, yes. Afib started at age 24.

Have you asked anyone in the medical office if they can turn yours up? Also, four months out isn't a long time for doing all the things you want to do. I was told it would take a year to get used to. After 3 yrs out, I have felt more comfortable and now I go in and out of my comfort zone. I am very aware of my sensitivity that goes on in my body/mind. What I have left anyway.

Always call the office and even talking with a nurse who deals with these questions everyday - I feel we need to be more in command in the decision making vs just letting people tell you. All opinions count. I found out many months ago that I in the state of Massachusetts can make the decision to turn it off, up, down and out if I so choose. I get this decision making because it is an artificial support system and now the state just passed (like in Oregon) that if you are terminal we can choose to live or die. If you didn't have the pacemaker, would you live or die. I prefer to choose life, but I do have a choice so I will continue to seek out what I need at the time when it comes to my settings. The pacemaker will let you know when it needs replacing. It should go down in stages over a period of time. Then the whole unit is replace which is called the battery and hopefully the lines to the heart do not need changing. I went from needing one in 5 yrs to needing one in 7 yrs so I now have about 4 more yrs to go. The computer will tell you how much time is left.

Call the doctor's office with your list of questions and hope you get some good info.

Sugar

pacing

by Tracey_E - 2012-12-15 09:12:33

If your heart is going to 155 but your max is 140, then you are beating on your own. All the pm does when you beat on your own is watch, it will never pace you higher than your upper limit. If you feel good, don't worry about it.

Watching you on the treadmill is the best way to test out settings and find the best mix that works for you. Sounds like your dr is on the ball, but sometimes it can take more than once.

There are two upper limits. One probably doesn't affect you, ventricular upper limit. If you have av block where the signal doesn't make it from the atrial to the ventricles, the ventricular lower limit is the highest the pm will pace the ventricles when they get out of sync with the atria. In this case, which I suspect is what's going on with Jill but not you, your hr will not go over the upper limit because your ventricles are fully paced. In your case, I would bet you don't pace ventricle much, if at all. When the atria is above the upper limit, it feels yucky because the heart is out of sync.

The other upper limit is how high the rate response will pace the atria. The way rate response works is it senses physical movement. If your hr doesn't go up appropriately with exercise, it raises it for you but only to your upper limit. When you max out, it doesn't feel good because you need a higher rate to sustain the exercise but the pm won't take you there.

I don't pace this way so I don't know a whole lot about it but my first thought is maybe the rate response is raising your rate too quickly. Or possibly the exercise is triggering afib. Either of those could make you SOB. You are going higher than your upper limit so it appears you beat on your own when exercising.

Don't rely on the HRM. If you think your rate is too high, stop and count it manually. Sometimes the HRM picks up pacer spikes as well as the heart beats so it shows a number too high.

Most pm's have a possible upper limit of 180, one Medtronic goes to 220. If you need it, they should be able to turn it up higher than 140, but if you are beating on your own during exercise, it's irrelevant what the upper limit is.

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