Best pacer for runners?

This post appeared in the General section. I thought the Exercise and Sports section would be most appropriate. If not, sorry for the duplication.
I have been running for 50 years. At 67 I’ve developed bradycardia and heart block. I can’t run 10 yards without feeling the shutdown. No passouts yet, but of course I am planning to get a pacemaker. My cardiologist at the University of Washington says I can expect to resume running, cross country skiing, weightlifting, playing golf. So does anyone have any experience suggesting which pacemaker would be the best for my interests? There are so many brands. I’d really like to know which can easily handle increasing HR with increasing exercise, and which have the lowest risk of a wire lead wearing-out and breaking?

6 Comments

pacing

by Tracey_E - 2016-04-14 10:04:41

Best is relative. With av block, your heart is setting the pace, all the pacer does it complete the broken circuit and make sure the ventricles beat when the atria does.

You'll see a lot of discussions here about rate response. That's the biggest thing that sets most of the pacers apart. However, rate response kicks in when the sinus node doesn't, which is not your problem, so don't stress over the rate response because you probably won't use it. They all work pretty well for runners anyway. It's the cyclists that run into problems and need to carefully consider which rr is best for them.

For heart block, they are all pretty much the same with two caveats. The important thing is who is going to maintain it. My doc has a great relationship with the local St Judes rep. I've known him for years and he is amazing, so when given the choice of switching to another brand, I said no thanks, I'll keep my SJM rep. I have a friend who lives in a rural area and had a Boston Scientific. She ran into problems with her settings, there was only one rep in the area and he couldn't help her so she eventually switched to Medtronic simply because they're bigger and have more reps she could access. So, bottom line, ask your dr which one he prefers. They all work well. They are all reliable. Go with the one your doc is most familiar with and has good reps nearby.

Now, for those caveats. It's tempting to get the MRI-compatible devices. Some of them only go to 150, which is likely not going to be fast enough for you. That means if your atrial rate gets over 150, the pacer won't keep up with the ventricles, it'll max out at 150. Also, mri-compatible doesn't mean you can go just anywhere and get an mri. Only certain facilities can do it and there is a protocol to follow. More and more hospitals can safely do mri's on the regular ones, so don't sacrifice function for mri-compatible.

Second caveat, find out how high you get when you run. Atrial rate, not pulse! With heart block, they are two totally different numbers. If you ran with a Holter or had a stress test, they can tell you what your atria does on exertion. Most pacers go to 180. If you don't get that high, then you're good with any of them. If you get higher than that, SJM and Medtronic each have one that goes to 220 so one of those would be a better choice for you. I hit 180-190 when running. I was always bumping my upper limit and it kept me from getting a good workout so I spent the last 6 years on a beta blocker to keep my rate down. I got a new one last month and the new one goes to 220 so I just finished weaning off the beta blockers, yay!

Leads are pretty much created equal. How they are placed and luck affect how long they last. Average life is 15 years but they can last half that or triple that. Usually we have no idea why they stop working. I have one that is from 1994 and still going strong, the other was replaced 5 years ago, insulation ruptured on it. It just happens. They'll usually last through several device changes but they do not last forever.

Make sure your surgeon knows you are very active. Some place it just under the collarbone, just under the skin which can get in the way with some sports. If they put it a little lower and deeper, you should be able to safely do whatever you want. Mine is between the pectorals. I run, ski, lift weights, kayak.

Hope that helps!

Third caveat

by IAN MC - 2016-04-15 01:04:28

When you see your Dr ask him the question :-

Although you just have heart block and don't need the rate response function at the moment, what are the chances of you needing it at some time in the future ? If you do develop chronotropic incompetence and need RR at some time then the PM which you choose now could have a massive impact on your future quality of life.

With your sporting interests I would strongly recommend that you avoid a PM, such as Medtronic , which has a sole sensor dependant on upper body movement. These are not totally satisfactory for runners in my experience.

Best of luck

Ian

Thanks a million

by tcportman - 2016-04-15 02:04:56

Wow! Thank you so much for such a comprehensive response. My PM learning curve just jumped up 100%. I am seeing my electrocardiologist/surgeon tomorrow for planning. I think I'll show him your response. I'll post the outcome. I hope someday I can be as helpful to someone.
Best regards, Chis

Thanks again

by tcportman - 2016-04-18 07:04:41

I read much of your responses to my doctor at UW. He was very impressed and kept saying "yes that's right!" He wondered if perhaps you yourself are a doctor. In any case, he is in fact concerned about my response rate and thus recommending the Boston pacer with two leads, especially because this device raises heart rate based on respiration increases. With this it seems I will be better able to run, x-country ski, and bike, etc. With my resting heart rate now down under 30, we've got the implant scheduled. Thanks so much, Chris

Chris

by IAN MC - 2016-04-18 09:04:52

I think you and your Dr have made a good choice.

Best of luck for the implant, it really is no big deal !

Cheers

Ian

good luck!

by Tracey_E - 2016-04-23 08:04:54

Sounds like you're in good hands and your doctor is very thorough. Do you have a date yet?

No doctors on this site that I'm aware of, mostly just patients like me who ask a whole lot of questions, read a lot, and have been on this roller coaster a long time.

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