still struggling

I had my PM implanted in Oct 2013 for SSS and AV disease. I feel better at rest but when I exercise I still struggle. I do have the odd good day but for the most part I feel short of breath and fatigue quickly. I have to say Im nowhere near where I was before my surgery. I struggle to keep my heart rate up. It seems that for the most part during a run it stays around 129 or 132 and Im short of breath, yet my pm is set to 170 for my max. I had my pm settings adjusted to the most sensitive to help increase my hr but I feel like I just can't keep it where I need it. If I run as hard as I can and pump my arms I can get my gps to read 160 but I feel extremely fatigued and short of breath after only 1 or 2 hundred meters and have to stop to recover. Any advice or thoughts would be appreciated. Thanks.

3 Comments

Hi ferniegirl

by IAN MC - 2014-04-27 03:04:50

I see that you have a Medtronic Advisa which is the same PM that I have myself . It is possible that you are suffering from the limitations of the Rate Response function which Medtronic uses.

As you know it is Rate Response which ensures that your heart rate increases with exercise, and Medtronic only has an accelerometer sensor . This responds only when movement of the PM is detected unlike some other manufacturers who have sensors which respond to increased breathing.

All I can suggest is that you describe exactly to your PM gurus the problem you have in getting above 130 bpm. There are various algorithms which they can try to adjust the slope and intensity of changes in heart rate.

It is just possible that they haven't explored every variation in setting.

I went through exactly the same process a few weeks ago. My HR was refusing to go much above 90bpm . Thanks to a very knowledgeable PM technician I am now enjoying running again.

But it really does depend on what level of chronotropic incompetence you have. SSS can cover a whole range of malfunctions in the sinus node and one sad fact is that Rare Response functions may never match the physiological HR increases that you used to enjoy.

Best of luck

Ian

Thanks for your support

by Ferniegirl - 2014-04-27 04:04:19

I really appreciate you taking the time to respond, this is exactly why I love this site. Having support from a variety of people is so helpful especially if you can relate. Having the same PM and the knowledge that you have just made me smile knowing that things can get better. Thank you.
Chronotropic Incompetence is a scary term that I have come across while reading about my situation. I hope I am fixable :)

chronotropic incompetence

by Kluge - 2014-05-10 07:05:46

A few years ago, after several years of inactivity I decided to get back on the bike. My pulse would not go over 100. I could push myself to exhaustion and it would not go over 100 until the day it did. After that it would not drop below 100. After a couple of years of 100 to 120 pulse I was put on Lopressor. Then I had 110 by day and 35 by night. Now I have a pacemaker and I sure wish I had never tried so hard to push it over 100.

My thought for you is to be careful.

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I had a pacemaker when I was 11. I never once thought I wasn't a 'normal kid' nor was I ever treated differently because of it. I could do everything all my friends were doing; I just happened to have a battery attached to my heart to help it work.