Do I need Rate Response?

Hi all. I'm looking for some guidelines to help me decide if I want or need rate response. I've read quite a few posts where some people have turned RR off.

I have SSS, Brady and VVS. Prior to getting my PM (Aug 26, 2013) I had a couple dozen syncope episodes over the last dozen years, but most of the time I felt fine. I wasn't aware of any problem when jogging or bike riding. I have to admit I am way too sedentary and don't get a lot of exercise, and my energy has been low over the years, but I figured that was mostly due to Brady and being an out of shape slug!

I have a Sorin Reply DR, but don't even know how it is programmed at present. I suspect RR is turned on, but I will find out at my next EP appointment on Nov 13th. I just want to be prepared for my visit. I will leave this coming appt with a complete copy of all settings, reports, etc.

Thanks for any comments or guidelines to help me decide if RR is for me.

10 Comments

Not necessarily !!!!!

by IAN MC - 2013-10-21 01:10:23

Sorry Tracey you cannot say so definitely " With SSS you want it on " as my situation proves.

You may be confusing SSS with chronotropic competence, the two do not necessarily go together.

Ian

tes

by Tracey_E - 2013-10-21 01:10:25

Rate response is primarily for SSS, so yes you want it on. Sorin is a really good one if you need rr.

Hi ibdina

by IAN MC - 2013-10-21 01:10:30

I think that is a very good question and not as easy to answer as you may imagine . It is very easy to tell you that if your heart rate increases with exercise then you don't need RR turned on, if your HR doesn't go up then RR may help you.

But not every situation is clearcut , I believe that some people are on the borderline , the sinus node may or may not trigger off an ADEQUATE increase in heart rate while exercising. Like you I have SSS and had a PM fitted for bradycardia . I started off with RR on and then had it switched off because it felt better for me without it

It may be a case of trial and error for you to find out whether it is better for you or not. It will be interesting if Pacer Rep chimes in because he no doubt looks at various histograms on the printout and makes a decision on the RR setting on a best guess basis but only YOU will know how you feel when you exercise.

You can easily tell whether RR is switched on or not ..firmly tap on the PM with your finger and if RR is switched on your heart rate will go up . If you have a printout of your PM settings you will see something like DDDR if Rate REsponse is switched on, something like DDD if it is not; the letter "R' is the clue

The fact that you are asking the question makes me assume that you are not 100 % happy with the way you feel. If you feel great now you don't need RR , if you get unduly breathless when you exercise you may benefit from it!

Let us know what you decide

Cheers

Ian

Agree

by golden_snitch - 2013-10-21 04:10:40

I was about to say the same as Ian: I know at least two people who have their sinus bradycardia at rest only. One friend had heart rates of 25-30bpm when sitting in her office, but she was perfectly fine as soon as she stood up, walked, exercised. She doesn't have the rate response turned on, her sinus node functions well when she exercises. However, I think it's true that most cardios would switch the RR on in an SSS patient - especially if he hasn't looked at the holter monitor results from before the implant.

Lou, you sound like you are the one to make all those decisions. Don't make the mistake not to trust your EP, cardio, pacemaker tech or whomever. I mean, you are doing pretty well right now, aren't you? So, apparently, whoever did the first programming of your device, did the right thing and knew what he was doing.
I do understand that you want to know what your settings are; people with a technical background often want all the details. Just remember that optimizing settings is teamwork, after all.

If the RR is switched on, but you do not need it, you'll most likely feel this. Patients who don't tolerate the RR because it competes with their own rhythm, often have symptoms right from the start. Those are often the ones who feel worse after the implant than before. Since you seem to be ok, whatever is programmed at the moment seems to be right for you.

Good luck!

Inga

My RR is Off

by Many Blessings - 2013-10-21 11:10:29

Hi,

I am constantly on the move and very active. Even when I'm sitting still, something on my body is moving. My RR was originally set to where it would work for a very active person. That didn't work for me at all. They tried adjusting it and I felt even worse. Luckily, someone out here suggested I have it turned off to see if I felt better. They did shut it off and after that, I felt great. It really was that simple. My PM tech and doctors still laugh, because they can't believe I feel better with it turned off.

Bottom line, I think it's just different for everyone. What is supposed to work for most, doesn't always work for everyone. Like others stated above, I think it will just take some trial and error before you know what's going to work for you. Don't be shy when experimenting with the setting changes. If you feel better, let them know. If you feel worse, tell them right away so they can change it back. Only you know what makes you feel better.

Good luck, and hang in there. Sometimes it takes a few tries to get things right, but you'll get there!

Rate Drop Response ?

by IAN MC - 2013-10-22 01:10:01

Hi I think what you describe as the Acceleration feature is also described as the Rate Drop Response ( RDR ) which, as you say, throws in loads of extra beats if your HR falls too suddenly.

I am intrigued , how do you know that you are having more rapid increases and falls..is this based on symptoms or are you measuring your HR during the night ?

I can see why RR could increase the number of times your HR suddenly rises but not your increase in the number of rapid falls ; I wonder if the RDR feature needs fine-tuning ?

I am no expert though and hope that someone with more knowledge contributes.

Ian

Sorry !

by IAN MC - 2013-10-22 01:10:07

I sent my last post before your last one came through; as I thought it is likely to be the RDR and not the RR which is causing it.

I hope you get it sorted out

Ian

Some feedback from Sorin

by lbdina - 2013-10-22 01:10:38

Just thought I'd update this thread. I sent an email to a technical rep at Sorin about my frequent rapid heartbeat episodes at night, and he provided the following response. He believes it is probably the Acceleration feature, and that the Hysteresis and Rate Smoothing parameters need tweaking. Sounds like it is set a bit aggressive at present, which makes some sense, since this was my primary reason for the PM. Here is his response to my questions:

-------------------------------

It’s unlikely what you’re feeling is due to the rate response function. Even if rate response is enabled and active on your device, it operates in such a way that it increases/decreases your heart rate gradually based on sustained physiologic activity, not isolated movements.

It could be that you’re feeling the acceleration function as it does increase your heart rate quickly before decreasing it gradually, though most patients don’t feel this. Basically, the way it works is the pacemaker is constantly monitoring and averaging your intrinsic heart rate (this average is updated constantly and derived from the previous eight normal heart beats). When the pacemaker detects a pause in your heart rate, it activates the acceleration function.

The pacemaker’s definition of a pause in your heart rate is adjustable and defined by the programming of its Rate Smoothing and Hysteresis parameters which are applied against your current averaged heart rate. By adjusting the values of the pacemaker’s parameters, the operation of the acceleration function can be “fine tuned” making it more or less aggressive for both the amount of pause in your heart rate required to trigger the application of an acceleration sequence and the percentage of heart rate increase that occurs when an acceleration sequence is applied.

Ian...

by lbdina - 2013-10-22 02:10:55

...thanks for the responses. Yes, I believe Sorin's Acceleration feature is the same as what you call Rate Drop Response (RDR).

I'm usually in bed with the lights off when this happens, so I am not taking my pulse and counting bpm. But, it definitely is a high rate, probably around 120 bpm, and the way it slowly ramps down is like what is described in the Sorin Implant Manual. So, I'd guess the settings for the Rate Acceleration feature may be a bit too aggressive and need to be adjusted.

Since I was passing out so frequently, I am guessing my EP programmed it aggressively at first to totally prevent future crash and burn episodes. I'll talk to him about my nighttime episodes and see if he feels less aggressive settings would be appropriate. I'd rather have my heart racing a bit a few times each night than experience another meltdown, but like most people, I want both if I can get it.

Thanks!

by lbdina - 2013-10-22 09:10:35

I appreciate the responses.

I have generally felt fine since I got my PM on Aug 26th, but I have noticed that my heart races for short periods when I am in bed. It will be normal, then suddenly will go much faster (maybe double speed) for 30-60 seconds, after which it slows back down.

My Sorin Reply DR has two features that may be causing this—Rate Response and Acceleration. I'm thinking it is the RR feature, because I usually notice this when I roll over or move. I'm wondering if RR accelerometer is overreacting or is set for the most active level. I wouldn't think rolling over in bed would make it ramp up my heart rate.

The Acceleration feature is designed for people with vaso vagal, orthostatic hypotension or rapid drops in heart rate, which describe me. When the PM detects a rapid drop in heart rate, for whatever reason, it steps up the heart rate rather quickly to prevent syncope episodes, then gradually slows it back down after heart rate is stable. While I have had these rapid heart slowdowns and stoppages in bed before (pre PM), they were fairly infrequent. This happens multiple times every night. If my HR is dropping precipitously, then the PM is doing its job and I'm thankful for it. But, it seems way too frequent, and I suspect it is the RR feature that might be doing this.

Maybe my EP can check me out on a treadmill with the RR turned off and see how I respond. I'll let everyone know what I find out.

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