Trouble with Rate Response

Hi
I am a 62 year old male and had a dual lead PM installed 3.5 weeks ago. It was tough going the first few days, but things got considerably better, with no issues. I went for my 3 week check with the EP at about 2.5 weeks , as he was going to be out of the office.
At that time he said it is his practice to turn on Rate Response, which he did. From that point on, I started getting these odd sensations in my chest. It almost felt like I was getting this odd beat, almost in my throat. It happened 15 or 20 times a day. I called the Doctor and he said give it a few more days to see if it goes away, but I could tell he was skeptical that the rate response had caused any change or problem. As he instructed, I gave it time, but is did not go away, so I made an appointment and went to see him. They turned off Rate Response and the sensations stopped. (I should say that I had not done any exercise since the sensations started, as I was too concerned that something was wrong. These sensations all came "resting".)
It has been over 24 hours now, and not one beat sensation. The EP did not say much, but his NP said some people do not tolerate Rate Response too well.
My question is why was I feeling so odd and what was RR doing if I was "at rest" the whole time? Also, will there be any situations that would call for RR to be turned on? Am I OK without it?
Thanks very much for you thoughts on this.

Trapper99

4 Comments

Hi trapper

by IAN MC - 2015-03-27 02:03:18

I see from your bio that you have a Medtronic pacemaker for 2nd degree heart block.

I find it very surprising that your Dr normally automatically turns on Rate Response . you ONLY need Rate Response
on if your heart rate doesn't increase the way it should with exercise . The medical term for this is being " chronotropically incompetent " .. This is a common problem if you have a PM fitted for sick sinus syndrome.

If you have heart block , you are usually " chronotropically competent " i.e your heart rate goes up as it should on exercising. (This is not always the case as you may have involvement of your sinus node as well.) but I would have thought that it makes far more sense , if you have heart-block, to have RR automatically switched off as the default setting and then only turn it on if you need it.

If you get quickly breathless when you exercise you probably need RR on, if you can exercise OK without getting breathless you don't need it on

You ask what your Rate Response was doing ? well, a Medtronic PM will only increase your HR and give you those extra beat sensations when you move your upper body and you say this was happening at rest.

I can only think that the RR was set at a high sensitivity level where the slightest upper body movement like a sneeze for example could put in extra beats.

When he said that some people don't tolerate RR too well I do just wonder if he is i) switching it on for people who don't need it and ii) wrongly having it automatically set at the most sensitive level

But it sounds as though you are OK now

Best of luck

Ian

Rate response

by golden_snitch - 2015-03-28 10:03:23

Agree with Ian. It's strange that your doctor turned your rate response on, although you have a heart block "only". Heart block patients usually don't need this. Their sinus node is functioning perfectly well and is setting the pace. You only need the rate response on, if the sinus node is slow/lazy and doesn't increase your heart rate properly when you exercise.

My experience from many years in forums/support groups is that those patients, who don't need the rate response, but have it activated, do not tolerate it well.

The rate response kicks in whenever you move around, not just when you exercise. Depending on the sensor it works with, it reacts to any kind of upper body movement or when you breath harder or faster. And depending on its settings, it reacts more or less aggressively. In some patients it increases the rate way too fast with minimal exertion because it's programmed this way. So, even though you were not exercising, you probably felt the rate response kick in.

Glad you are feeling better now :-)

Me 2

by rolson - 2015-03-28 12:03:18

I have sss, brady/tacky and tons of pvc. After my pacemaker tech turned on RR on my medtronic, I could not shower, walk, laugh or walk, even slowly. I sat and did nothing or I was out of breath with my heart going like a train, down hill. After two weeks I figured it out, with a bit of reading in this site, that I'd was RR. A brilliant man named electric Frank had the answer for me. Had it turned off and could finally live. RR is not for every one. It should not be standard to turn it on. It's your heart and your pacemaker, let how you feel be your guide.

Thank you

by trapper99 - 2015-03-30 09:03:44

Thank you all very much for the time and effort taken to respond. I feel better knowing that there is good advice out there when you feel sort of helpless.

Thanks again!

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