Would love some advice

Hi everyone!
My names Anthony I'm 21 years old from sydney Australia.
I've had a pacemaker since I was 4 years old then replaced again when I was 13 and now due again in 4 months.
I'm having trouble deciding which pacemaker to go with. I have heart block of the AV. I am running a medtronic pacemaker with a single lead. (Accelerometer).

I haven't had an issue with it I've been very lucky but I am a very very active sporty kind of guy I ride dirt bikes and race work long hours and go to the gym. Although I can keep up with it all I feel during the sport I struggle esp when bicycle riding pretty much anything to do with lower body exercise like rowing ect.

Just wondering if anyone out there is very sporty and can help me decide as thinking of changing to a biotronic or something along the lines of that maybe a blended sensor I'm not to sure about all that. But am definitely trying to stay off the path of getting a dual lead as I am younger and don't want to many leads...
If anyone can help me that would be great!

5 Comments

Also

by Antman1993 - 2014-12-08 05:12:57

Also I noticed there a lot of bike riders and marathon runners here wondering what kind of pacemaker implants you have?
Thanks

Rate response needed?

by golden_snitch - 2014-12-08 06:12:08

Hi Anthony,

usually, with nothing but a heart block, you should not need the pacemaker's rate response function at all. In most heart block patients the natural pacemaker of the heart, the sinus node, works perfectly fine, so that it can still dictate the pace. All the pacemaker has to do in these patients is to stimulate the ventricles in the same pace that the sinus node is dictating. Your sinus node is superior to any kind of rate response sensor. If your sinus node is too slow, then the pacemaker you have with just one ventricular lead is the wrong model for you. In that case you'd need a dual-chamber pacemaker that can make sure the atria and ventricles beat in the same rhythm.

A problem some heart block patients face is an upper rate limit that it set too low or that is already at the max. There are pacemakers out there that have an upper rate limit of something between 150 and 180. If the sinus node dictates a faster pace than that, the pacemaker cannot track it, it can only stimulate up to that upper rate limit. There are some pacemakers, for instance the Medtronic Adapta, that have an upper rate limit up to 220bpm.

I've tested all rate response sensors that are currently on the market: accelerometer, accelerometer + minute ventilation sensor (blended) and closed-loop stimulation (CLS). For active patients with a lazy sinus node I'd always recommend either a blended sensor or CLS, never an accelerometer only. CLS is a bit tricky, and after almost a year with it, I'm at the point where I would say, if possible, I'd rather have a blended sensor - but unfortunately I cannot have that any longer due to epicardial pacemaker leads (minute ventilation sensor does not work with those).

Hope this helps!

Inga

Thanks

by Antman1993 - 2014-12-08 06:12:18

Hi Inga thanks heaps for your response!

I know that my pacemaker does have the upper rate limit of 180 and my pace tech always tell me when I go for check ups that I reach the 180. Through years of knowing my body i know the only time I hit 180+ is from running the problem I am having is when I'm doing more sit down exercise like the bicycling or even when I'm riding my dirtbike because there is not much upper body movement and am struggling for it to get up the beats.

Do you think getting a blended sensor pacemaker may improve those exercises at all. I know the old saying don't try fix what is not broken but if getting a blended pacemaker can help even by 5% I don't see the harm!
Thank you again much appreciated!

Anthony...

by golden_snitch - 2014-12-08 08:12:11

Why do you need the rate response? From all you write here I do not understand why you should need it. The rate response sensor question only applies to patients with sick sinus nodes, not to patients with a heart block only.

If you need the rate response because you have a sick sinus node, then you also need a dual-chamber pacemaker. Rate response should not be regulated by a ventricular pacemaker lead (unless the atria are in permanent atrial fibrillation), but by an atrial lead. You need to make sure that atria and ventricles are beating insync. A ventricular lead with rate response activated is likely to put the ventricles in a different rhythm than the atria.

From my experience, a blended sensor or CLS does help, but to make this clear again, it helps those with a sick sinus node and chronotopic incompetence (inability of the heart to adapt the heart rate to exercise).

Inga

heart block with athletes

by Tracey_E - 2014-12-08 08:12:58

Have you been on a treadmill to see what your heart is doing when you are pacing at 180? It sounds like maybe your atrial rate is going higher than that, which is normal for a healthy 21 yr old guy. As Inga said, rate response is for when your ATRIAL doesn't go high enough on its own and you need the pacer to help get it up. Your atria seems to be fine, you just need help getting the ventricles to keep up so the heart is in sync.

There is a Medtronic that goes to 220. That might be a good choice for you, but you will want to confirm first that your atria, indeed, gets higher than 180. This would mean going to a two lead (pretty sure it does not come in single lead) but I would probably want to do that anyway if I were in your shoes. Most of us with av block have 2 leads. Theoretically we only need the ventricular but sometimes it comes in handy to have the other one. I also have av block. I pace 100% ventricle, 4% atrial. Sometimes my atrial rate takes a nosedive when I am working out, the pacer kicks in and keeps it up. We didn't even know I had this problem until I got the first pacer and tried to work out so I've always been glad I started off with 2 lead.

You know you're wired when...

You name your daughter “Synchronicity”.

Member Quotes

Without this little machine, we would not be here.