ICD Settings and Rate Response?

Hi, so I was implanted with an ICD in April. I am also on beta blockers. I am athletic and run. I suffered from a SVT while running prior to that and a fainting episode. I have scar on my ventricles and with every test imagineable, it remains undiagnosed. So I am back at running, with my trusty heart rate monitor. Not as much as before, and much slower, but happy and feeling good. My rate response for my ICD is now off. I have a little residual fatigue and my doc suggests we turn the rate rsponse on? I worry that it will get my heart rate too high for my needs. Does anyone have experience with this? And what are your general settings? My low is set at 60, my ICD begins to monitor at 145 and shock at 175 if it cannot outpace me. But I cannot get my heart rate over 140, and when I run it usually is is in teh range of 126-140. Thanks for any info!

8 Comments

Rate response

by golden_snitch - 2014-07-30 01:07:04

Hi!

It could be that the betablockers are bringing your heart rate down a little too much, which can also lead to chronotopic imcompetence (inability of the heart to increase the heart rate appropriatly when exercising). So, a little help from your ICD's rate response feature might do the trick. You can program a max. sensor rate (rate response rate), for instance, at 160, so that at least you will not be paced up to rates where the ICD starts shocking. What would be interesting to find out is, if the ICD can differentiate between a fast rhythm that is being paced and one that isn't. In my opinion it should be able to respond differently: If it's paced and sensor driven, it should know that this is not bad, but just because you are exercising; if it's fast and not paced, then this might be a dangerous rhythm that needs anti-tachycardia pacing and maybe also shocking.

Is there any particular reason why your ICD is set to shock at 175 bpm already? Just asking, because this is an outdated programming according to the EPs I know. Today, ICDs are usually programmed to start shocking therapy at 200bpm because this is associated with reductions in inappropriate therapy and all-cause mortality during long-term follow-up. Some interesting articles:

http://www.medpagetoday.com/Cardiology/Arrhythmias/35823

http://www.nejm.org/doi/full/10.1056/NEJMoa1211107

http://www.medscape.com/viewarticle/774032

http://www.cxvascular.com/crn-features/cardiac-rhythm-news---features/the-challenge-of-optimal-icd-programming

Best wishes

Inga

ICD and Rate Response

by natlat - 2014-07-30 01:07:49

Hi, thanks for the responses. I think the nurse told me incorrect info. It is set to shock at 220, but will shock if it cannot outpace me at 175 (I believe). I hate talking to nurses sometimes and prefer to speak with the doc. I am going in tomorrow for a followup and interrogation, than meet with the boston scientific rep for rate adjustment. My concern is that it will get too high when I run? What are the benefits of having a rate response on? Are there specific settings which would be better for me as an athlete?

rate response settings

by megsam - 2014-07-30 02:07:34

Try looking on the website of the manufacturer of your device. Mine (Medtronic) has a page describing the different settings for rate response. That'll give you more specific details to ask your doctor or representative about.

Settings

by Lurch - 2014-07-30 11:07:34

Just got back from my routine interrogation and confirmed that my settings are 40 on the low end and 171 on the high end. I have not had any pacing yet (ICD installed May of this year). Just my opinion, but if you exercise heart is generally 126-140 I don't think you would have a problem with your settings. But, if would be a good thing to discuss your concerns with your Cardiologist and Tech...

Beta Blocker

by ebfox - 2014-07-31 03:07:59

Hi Nat,

My response may be late, you are going to the interogation today-

You don't mention what beta blocker you are taking, and how much. Your residual fatigue is probably from the BB; also your heart's inability to go above 140 is due to the BB (that's what they are supposed to do, keep you out of Vtach).

I would advise you to talk to your doctor first about tapering your BB a little, with turning on RR only if you can't drug taper-

If you do turn on the rate response, don't be surprised if it takes a couple of adjustments to get it set right for you. One of the best ways is to put you on a treadmill with the pacer tech programming while you run.

Good luck-

EB

rate response

by natlat - 2014-07-31 04:07:19

Talked to the Doc, no rate response adjustment for me. The reason is that it would negate the effect of the beta blockers which deliberately take a load off my heart and keep my heart rate down. I am set to shock at 230. However, my ICD will monitor me from 145-170. If it detects something at 170 that it cannot outpace me from, then it will shock me. Going to keep everything status quo for now and take what I can get, some solid running and am pretty content for now.

Settings?

by natlat - 2014-08-01 11:08:16

One more thing, and a question. Originally my ICD low was set at 60, they adjusted it to 40. I cannot understand why. Any ideas? I asked the doc and he said that it was only to save battery life, but I question whether I will get more tired? and maybe they should not have adjusted it at all.

I am on sotalol 80mg 2x per day.

Thanks for the response.

How do you feel

by ebfox - 2014-08-02 09:08:30

Regarding your low setting, if you feel more tired, or mentally foggy, then raising the low back up would be the first thing to try. The doctor may feel that you are pretty fit and he is letting you go brady. Forty is pretty low though-

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