Medtronic CRT does not like hills.

Hi to all,
I had a medtronic Consulta CRT-P and AV node ablation 10 Dec, 2013, for heart failure, afib & cardiomyopathy. I was cans at last minute and rescheduled to Dec. Surgery went well went home the next day and recovered well except that my exercise tolerance dropped considerably especially on hills and stairs. Thankfully The RN at Pacemaker clinic, checked with manufacturer and it turns out the Implant Detection had not been turned off! After that I had better rate response.
On Jan 2, they changed a few settings 70-145bpm, RV amplitude from 3.5 to 2.00 (I think because I could feel one on of the electrodes under my breast). They also turned the acute phase off. I believe they said I was pacing around 99 %. I put more info in my bio.
I do have more energy, not napping as frequently. However I find that out walking I have trouble on stairs and hills. It seems that the machine does not want to respond after a certain grade of slope so how ever much I flap my arms the heart rate will not go up. At the gym treadmill is ok I even get to max Hr, but stair master I last 2 mins with HR 90, elliptical is a bit better 10 mins Hr 90-100 and feel awful.
I think something in the rate response settings needs more tweaking. Does anyone have any ideas of what I should be asking for?
Also does anyone have any experience with sleep mode?
When I rest or sleep the Hr tends to keep me a bit wired. Just wondering if it will help me. Can't Ly on left side as I feel too much pulsing.
Another question. With the AV node ablation and a CRT will your heart rate go up when you are frightened, excited or is it just dependant on motion?
Overall I am happy with my decision to have the procedure but am the type of person who wants to know all the workings of the machine. So I ask tons of questions of the docs and for advice from you in helping me understand my new best friend. Just ended advice on questions for doc apt. Next week.
Cheers
Anne

8 Comments

I was going to ask

by Theknotguy - 2014-01-20 08:01:18

I was going to ask what meds you were on but then remembered you had an ablation. So you may be off meds. I'm on a Medtronics Sure Scan. The reason I've got the PM was because of problems with a-fib.

What you may be describing is something called chronotropic incompetence. That's where your heart doesn't come up to the rate quickly enough to support the activity. I have it because of the meds I'm currently taking. So when I start walking, I'll go up to 3.2mph but my heart won't go above 109bmp. So I get angina. I'll be 15 minutes into my walking before the heart rate comes up to match the activity. While you may not have the chronotropic incompetence it's a question to ask your cardiologist.

Don't know about sleep mode. They've left mine at 60bpm but reduced the voltage after 90 days. I've slept much better since then because my heart isn't thumping so hard. They may reduce the voltage after 90 days after your heart is "trained". So your inability to sleep as well may be to the higher voltage. I thought I'd never get a good night's sleep post PM. Then they dropped the voltage and I've been out like a light.

Can't lay on my left side either for up to 90 days. Although after 90 days I sometimes find myself a little on the left side. So that may change after a while for you.

Heart rate will go up after stimulation. Got into a "discussion" with my spouse. Heart rate went up and the PM went up with it. Then went back down when I calmed down. While exercising, it'll go up with the amount of work I do.

Elliptical for 10 min? Wow! They'll only let me go for 2 1/2 min on the elliptical. What's the trick?

You only got your PM in December. I got mine in October. So you need to give yourself a little time for your body to adjust to the new situation. My biggest change was my heart couldn't go off on its own way. It had to march to the beat of the PM. I'd get coughing jags because the heart didn't want to beat and the PM stepped in and forced it to beat.

You may need more tweaking of the PM, but they may want you to hold off until you've had a little more time to settle in. I didn't get real comfortable with mine until after 90 days. Then had a little more adjustment after they dropped the voltage.

Looks like you're adjusting very well. I'm really happy to see someone doing so well. Hang in there. You've got a lot of living to do!

Theknotguy

CONSULTA

by Vinnie - 2014-01-20 09:01:45

Hi Ann, I had the CONSULT CRT-P put in June 2013. I'm 76 years old and had AV-ABLATION in 2007. I had some rate response problems at the beginning and they reset the response to medium about 2 months ago---- it was better but I still have some problems. I am set at 60 & 130 BPM --- when I'm sitting watching TV I'm at 60 BPM then if I get up and walk slowly around 50 FT I'm up to 102 BPM if I keep walking it doesn't go any higher but slowly comes down to around 90 BPM and stays around there. As far as stairs go; when it was first installed after climbing 23 steps I was up to around 120BPM then after the changed the rate response I manage the 23 stairs much easier. I'm thinking of having the rate response changed again ( while on a treadmill ) and see if that helps out. I also think the high side could be changed to 140BPM because now after I eat and walk a distance I get exhausted fairly quick. I'll see the Medtronic people in April- in the mean time I transmit my date to Medtronic every 30 days so the can see what's happening. Besides the AV-NODE ablation I have CHP- hope this info is helpful.
Regards
Vinnie

For angry sparrow

by Vinnie - 2014-01-21 07:01:27

Thanks for your info. on getting tired after eating.
Regards
Vinnie

Thanks for support

by Anne53 - 2014-01-21 08:01:28

Thank you for all your support and ideas.
I forgot to list meds..synthroid ( hypothyroid courtesy of amioderone) ramipril, carvedilol and Xarelto. I have been told I will probably be taking them for ever, which is no big deal.
I am getting used to "my new best friend" don't feel it much until the evenings when I am tired or have used the left arm too much. As you said I am only 6 weeks in, so have to be patient which is hard.
Someone mentioned that rate response activity threshold could be set to medium, mine is at medium/low so hopefully it could be changed to work more quickly. I am beginning to feel that a wider range of perhaps 60-155 might work for my activity levels. There are 9 different settings in rate response; so it is really hard to know what to ask for, I am just going to write down whenever I get a symptom and hope they can fine tune it. As I really would like to burn up the hills and stairs. I am a young 60, who has spent 2.5 years feeling lousy, now I want to get as well as possible so I can enjoy life again.

The appt is on Monday so I will post again here to let you know what changes they make.
Cheers
Anne

You may check

by KAG - 2014-01-21 10:01:29

to see if increasing your upper rate would help. Perhaps 145 isn't high enough to support your activities.

Kathy

An activity log

by KAG - 2014-01-23 10:01:43

is a good idea. Jot the date and time down too. They can check it against your PM data and see if anything correlates.

I'd suggest that you take it slow on making to many changes at once. By that I mean, don't do more than one change at a time. That way you'll know if it helps or makes it worse. Perhaps they can make a change and you can find a stairway and try it out before you leave. I've heard of them using a treadmill to try things out too.

Keep after it.
Kathy

Update

by Anne53 - 2014-02-04 11:02:58

Well I saw the cardio folks last week and they made a change to the speed of rate response, but left both upper & lower at 70-145. Apparently I have only got to 130 ( although it went to 145 on my heart monitor).
So hills are are a little better, so will give that a go for a few weeks as I know I don't have a much strength as before afib. Stairs are still a big problem but they said they can tweak that too. Just have to be patient with one change at a time. I was told I was more sensitive than most people. Perhaps it is because I want to get out & live life at full speed & do the things I love skiing, hiking & wear my passport out!
They also agreed to lower me to 60, so hopefully I can rest more.
All in all, I am happy with the procedure feeling so much better, like 45 not 60. Hope hubby can keep up.
Thank you so much for you support these last few months.
Anne

Medtronic CRT does not like hills

by lucienp84 - 2014-02-17 11:02:55

Hi Anne, check my blog lucienp84.blogspot.com for suggestions for dealing with hills. Basically, you need to increase sensitivity and possibly increase the Daily Activity rate setting to 100 and possibly to 105. To avoid getting overpaced when not climbing or on downlhills, set the upper limit to 80% of your max rate, around 130 bpm if you are 60.
If you make adjiustments one small step at a time, you will be a very old lady by the time they are done. Get them to put you on a treadmill and make adjustments while observing their effect while you are exercising.
Lucien

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