Latest changes ???

Had follow up visit to PM clinic, after treadmill run with monitors, they told me everything looked normal paced to app. 125 while running app 10 min at 9-10 min pace. I felt slightly tired but beginning to struggle staying aerobic. They made a minor change to the activity acceleration from 60 to 30 which was one of the original settings when I felt better. I went and ran app 25 min outside and it was still border line anaerobic, but the improvement was I was able to run the whole time without the stop and starts I was complaining about.
Meet with PM tech after and I begged her to change the rate response. She reluctantly agreed and made some changes which I'll not at the end of the post for comments please, PacerRep and others please. Since this I have had a gradual improvement of my runs over the last wk. there was a immediate improvement so I thought we were on to something. I have taken a couple of rest days to insure overtraining or cardiac fatigue was not also involved.
I can now seem to run more comfortably, that is not always breathless. My times or rather pace improved immediately and perceived exertion was more in line with pace breathing, etc.
So I know I'm not where I need to be yet and I'm fearful my next visit I'll have another battle to make another tweak, 3 wks out from now.
The other issue is I forgot to ask for a printout while there and had to call to get one faxed,, when I got it's totally different format and she says that's all that's able to get now from her computer. Here are it's information
Mode DDDR
Lower 60
Tracking 150
Sensor 150
Husk./sleep NA/O
Av-paced 300
Av-sensed 140
Blank Refr. Sens. Pol. Amp. Dur. Pol
180. Auto. 0.50 B 5.000 @1.50 B. A
28. 230. 5.60. B. 4.500 @0.76. B. V
Adaptive AV Delay. Off
Sensor:
Threshold. Med/low
Slope. (Blank)
Accel/react. 30
Decel/recovery. Exercise
AMS. Rate 175
.????? No delay. (Can't read the word in front of no delay)
PMT Opt.
PMT Off
PVC. On
Diagnoses: Sick sinus syndrome

9 Comments

DDDR for SSS?

by golden_snitch - 2013-10-17 03:10:54

Hi!

One question: Why are you in a DDDR mode when you have sick sinus only? You should either be in mode switch from AAIR DDDR or in AAIR only. Do you know how much you pace in the ventricles?

And why is your upper rate 150 only? The Adapta can go much higher, up to around 210-220. Considering that you are a very active person who likes to run, I'd say that you can have at least 170-180bpm as upper rate limit. The 125 during the treadmill test were when you were running at 9-10 miles per hour or what (you wrote "minutes")? If so, that sounds a little low to me. I mean that's quite a fast pace; when I run at 7-8 km/h they say that I should be at around 120-140bpm, but you are running so much faster.

It's great to hear that you already see an improvement. Fine tuning needs time, so be patient and just keep asking for tweaking until you feel fine.

Best

Inga

Runners take note

by ebfox - 2013-10-17 04:10:06

Hi Still,

Sounds like you are making progress. There have been bunches of posts from active (and semi-active) PM'ers wanting to know how to get Rate Response set right and you are doing it the right way. Even if your pacer tech is reluctant, that is much better than many who won't do anything, let alone get the patient on a treadmill.

I totally agree with Inga, your upper rate should be much higher considering what you are doing.

I am envious and I don't have a pm anymore. Good for you-

E. B.

Agreed!

by Moner - 2013-10-17 05:10:16

Hi Still Running,

Inga gave great advice, I find it irksome you mentioned the PM Tech was relectant to adjust your setitings. She's not the one walking around with the pacemaker.

Knowledge is power, be adamant about what you need.

Good luck!

>^..^<

Settings

by PacerRep - 2013-10-25 11:10:43

Your paced AVD is really long, 300ms on a paced AVD vs 140 on a sensed AVD is absolutely ridiculous. there should only be around 30-50ms difference. Bring that Paced AVD down to around 205 and turn on Dynamic AVD.

The sensor they are going to have to play with, there is no one size fits all here.... Increase the aggressiveness of the threshold and slope, if they raise the max rate from 150, the aggressiveness will naturally increase on the sensor.

Not sure why your PMT algorithm is off either, that should be on in everybody, Medtronic's have a horrible problem with it, especially if you have retrograde conduction.

If you conduct to the ventricles on your own without rate induced heart block, you should be in MVP mode, not DDD.

Settings

by Stillrunning - 2013-10-27 11:10:29

Thanks I have no idea what this all means, so I guess I'll just print this out and take to my appointment and ask why not this????
IF, I just have them make these changes and go to the parking lot to run what do you think I will feel , running wise ????

Settings pacer rep ??

by Stillrunning - 2013-11-04 04:11:15

I have app for review on this thurs,,,afraid to screw up where I'm at ???
If turn dynamic AVD on what will that effect ?
If change the paced AV from 300 to 205 again what effect ??
PMT on vs off ??
And switch to MVT out of DDD what happens running
And I kind of assume I request raise max rate to maybe from 150 to maybe 170 ???

Setting reply to Pacer rep

by Stillrunning - 2013-11-06 06:11:07

Thanks I missed all this input before, this really helps,, I'll try to see where I get tomorrow,, again thanks as always

Also I read about the PMT on the Medronic site and it seemed like they were also recommending that it be on,,

OK

by PacerRep - 2013-11-06 11:11:51

Dynamic AVD is just an algorithm that allows the device to help your heart beat on it's own at different rates.

PMT on vs Off, don't worry about this one, it would be a long conversation to have, basically pacemakers can confuse an atrial beat sometimes and it causes the device to pace faster, PMT 'on' will help stop it.

300 is a long time to allow diastolic filling, but if that's what your physician wants for you...so be it. 205 is closer to 20% of your cardiac cycle.

MVP will help your ventricles beat on their own.

The upper rate is up to you and your doctor. But it sounds like 170 is not unreasonable for you.

Pacer rep - new settings

by Stillrunning - 2013-12-16 01:12:12

well I was able to talk them into raising my upper limit to 160 they also lowered the Paced AV delay from 300 to 250,these they tell me were the only changes from 10/3 visit, they believe this will cause me to be paced more in ventricular,, this report indicated I'm passed 99+% in Atrial and 6+% in Ventricular, since I forgot to ask for the
regular report I had been getting on the 10/3 visit and had a different format which I wrote about previously
I also noticed the Rate Response is set on 4, Exertion response also 4,,,, ADL % 4.0,,,high rate % 0.5,,,ADL Rate Setpoint 25,,Upper Rate Setpoint 149.
Let me know what you think on these and their Vent. paceing comment. I still think I'm not paced where I should be as these changes didn't seem to be much different although I cant run a hard pace due to ice, snow, sludge etc on the roads now that winter has arrived in Indiana, the other unsettling issue is ever since I left the last app. I constantly feel and can see my heart beat numerous times during the day every time I get up and move walk or do any activity and that's entirely a new sensation and after 10 days its still there, I have a call in but they never call me back, thanks all,, out here ;)-

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