topping out

I had a dual chamber pacemaker implanted for av block and bradycardia 19 months ago. I was physically fit before the PM was implanted (biking 20 miles a day, running on weekends, hiking). I have been able to resume these activities and am very grateful for the PM. However, I notice that I "top out" during my runs or bike rides. Basically, I reach a plateau when I am exercising and can't push past it. I notice it particularly when biking or running up a steep pitch. My PM has a maximum HR setting of 150 bpm.The technician has adjusted the PM on my last visit but this has not resolved the issue. My maximum HR should be around 168 based on my age. When I do the treadmill tests, I am at 150 bpm almost the whole time and the readings from my PM indicate that I am 150 bpm about 5 - 7% of the time. I am wondering if I would do better with a PM with a higher maximum setting. I notice that Medtronics recently came out with an MRI-safe version with max settings higher than 150 bpm. I'd be interested in knowing if anyone has had a similar experience or a recommendation.

3 Comments

Upper tracking rate

by golden_snitch - 2014-10-01 03:10:12

Hi!

Before surgery, did you talk to your cardio about which activities you would like to resume after the pacemaker has been put in? Just wondering, because if you did, and he put in a pacemaker with a max. tracking rate of 150, you should ask him what he was thinking. Stories like that really make me upset. MOST pacemakers already have upper tracking rates of around 180, some even 200-220 (the Medtronic Adapta has 220, and it's been on the market for more than 5 years) , but your cardio decides to take one of the very few models that can only track up to 150bpm for someone who bikes, hikes and runs. Duh!

Did you calculate your max. heart rate by subtracting your age from 220? I'd not do that, it's an out-dated rule. How much were you able to bring your heart rate up, before you had the heart block?

If you have big problems when exercising due to your heart rate being limited to 150, and if you don't want to give up any of your activities (or reduce the intensity), then replacing your Medtronic Revo with a device that has a higher tracking rate would surely help. But it's another surgery, and if I were you, I'd only go for it, if this 150bpm limit really bothers you. If you think, you can adjust to the max. of 150, don't do it.

Inga

how high can you go

by Tracey_E - 2014-10-02 08:10:36

I really don't think the formulas, no matter how sophisticated, apply to us once we are paced. Our electrical systems are messed up so throw out the numbers and go by how you feel. I don't even count when I work out. If I am sweating, if I can talk but not sing, then I'm where I need to be whether it's 130 or 180 (I've done both). I learned to back off when I get close to my upper limit. Stop, put my hands on my head (expands the rib cage) and take a few deep breaths to bring my rate down, then get back at it. I did that for years, then my rate kept creeping up (SVT, not from exertion). It got harder and harder to stay under my upper limit so I went on a low dose beta blocker.

So, rather than go by the formula to decide how high you should be getting, go by what your atria is doing when you hit the wall. With av block, your own sinus node is setting the pace. All the pm is doing is keeping the ventricles in sync. It can only pace you to 150 but your atria is likely going higher than that. That's part of what feels so bad, not just that your rate isn't going higher but that you are out of sync. They can tell from the pm reports as well as the treadmill what the atria is doing. If you're getting to 155, that's a lot different (and easier to deal with) than getting to 180. I would want to know how close you are. If it's a small gap, you can probably make do. If it's a larger gap, surgery for a different device might make more sense.

Like Inga, I don't know why any dr would consider a pm with a max of 150 appropriate for anyone young and active Older, ill, sedentary patients, it's more than sufficient, but it's problematic for the rest of us.

140 max

by lhogue - 2014-10-02 12:10:21

I had a dual chamber Boston Scientific PM put in three weeks ago. It's set at 50/140. I've been walking 4 miles every day and my HR doesn't go over 75. I've ran a few times and once it spiked to 160 for a short period of time and then pace me the entire way down. I decided to try spinning yesterday and no matter what I did I could not get my heart rate past 144. I know that mine can be adjusted because it will call in if I hit 170. I'm sorry to hear that yours does not go past 150. I'm with the other guy...it would have to bother me a lot to have the surgery done again.

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It is just over 10 years since a dual lead device was implanted for complete heart block. It has worked perfectly and I have traveled well near two million miles internationally since then.