Rate response turned off

I had my Medtronic A2DR01 PM implanted on 1-12-17 because of SSS tachy-brady. I had no energy and felt exhausted all of the time, even after taking 3 hr naps almost every afternoon. My pacemaker was set to 60-130 with the rate response turned on (I believe the "default" settings.) I'm 65 years old and my HR prior to receiving my PM was 38-40 bpm at night and hovered around 45 bpm during the day when sitting according to my 48hr HM, with Vtach spikes of 125bpm that quickly returned to the 40s. My cardio was most concerned with my "brady" because I would get very "light headed" during the day and when driving. I've had my PM for just over 2 weeks now and I do have more energy and feel much better overall. My issue was, every time I stood up and walked slowly about 100' my heart would start racing. It would go from 65 to 110 bpm almost instantly and made me feel out of breath, almost like I just ran 1/2 mile up a hill! I didn't have a problem with my HR going up on it's own before receiving my PM. I found myself not wanting to walk or do anything!

     I called my cardio office about this and they told me that I had an appt to see my Medtronic tech in 6 months and he can adjust my PM at that time. I told them that something doesn't feel right about the way I was being paced and I need to see the tech ASAP! They said that 6 months is our "protocol" and you will have to wait until then to get my PM adjusted. After telling them repeatedly on the phone and at their office about my issue, they finally made me an appt to see the M tech last Friday. I told him about how my heart races when I get up out of a chair and walk across the room and could that be the "rate response" function on my PM. He said "yes" and I will just turn it off! I feel really good now. I have more energy and my HR rises normally once again just like it did prior to PM implantation. 

     If something doesn't feel "right" go back to them ASAP and have them adjust your PM!

6 Comments

Keep on pestering !

by IAN MC - 2017-01-29 14:11:54

I couldn't agree more with you , SCOTTY , if something doesn't feel right keep pestering for another PM check-up even if the behaviour of your heart doesn't conveniently fit in to their  6 monthly protocol.

If you have SSS ,  should Rate Response be switched on or off at initial PM implant ?   There is no easy answer , it depends on whether you need it or not ( i.e. it depends on whether you are "chronotropically incompetent " or not )

Some studies have shown that ,at the time of implant ,roughly 50% of S.S.S. patients would benefit from having RR switched on. This rises to 70% for people who've had a PM for 4 yrs.  Chronotropic incompetence is progressive and can sometimes worsen over a short period of time after PM implantation.  This can also apply to people with heart-block.

So if any of us feel that we are not coping with exercise quite as well as we were at PM implant time then perhaps we should all follow your example and push for a check-up when WE need it !

Cheers

Ian

Similar Symptoms Standing Up

by Shaun - 2017-01-30 15:33:18

That's interesting, I have SSS Bradycardia and I was wondering recently whether the rate response on my dual chamber PM should be turned on as I sometimes find myself quite lightheaded and breathless (tight chested) for a few seconds if I stand up too quickly while I'm relaxed. It tends to happen more if I've been cycling intensively for a few days, and it goes away again if I then stop cycling. I did wonder whether the exercise might be causing some sort of stress on the heart muscle, but appart from the SSS all the tests have shown my heart to be very healthy. Also, I had an exercise stress test (Bruce protocol) and it showed an excellent haemodynamic response both in terms of blood pressure and heart rate. But I already knew my heart responded well to endurance exercise, it's the small responses required for trivial exertions (such as standing up) while I'm completly relaxed that can be problematic. Also, having low blood pressure does not help when it comes to standing up too quickly, so I suspect this is more the cause of my problem which is why I shall resist having the rate response activated for the time being.

Shaun

by IAN MC - 2017-01-30 16:24:34

Everything you have written sounds like classic " orthostatic hypotension" rather than a need to have RR switched on.

If it only happens after periods of intensive exercise then dehydration and / or low blood sugar could be a cause . Lots of other things can cause it ,  e.g. blood pressure drugs and some medical conditions..

It really does sound like a blood pressure issue rather than a heart-rate PM related one. I used to experience it occasionally when I was daft enough to run marathons and I always accepted that it was a nuisance rather than something life-threatening.

BUT it may be worth mentioning it to your GP and  getting it checked out.

Cheers

Ian

Thanks Ian

by Shaun - 2017-01-30 18:13:17

Those are very helpful comments and I shall mention it next time I see my GP. I'm just wondering though what the connection is to cardiovascular exercise and what I should be doing differently. I know I tend to push myself quite hard and in doing so sweat quite a lot (I can sweat 1kg of body fluiid in a single 45 min Turbo Trainer session). I also tend to drink quite a lot of water throughout the day and maybe this combined with my low salt intake is causing an imbalance.

Rate response turned off Update!

by Scotty66 - 2017-02-07 12:45:58

It's been 4 weeks since I've received my PM and 2 weeks since the the Medtronic tech turned off the rate response on my PM. I believe the PM has really helped me regain the joy of living once again! When I wake up in the morning now, I look forward to the day ahead once again. 

The rate response should of "never" been turned on to begin with, in my situation. I believe the Medtronic PM is set to standard default settings when it's implanted in most people. Wouldn't it make more since if they did a little more testing (than a 24 or 48 holter monitor) before receiving a PM? 

One size doesn't fit all!

4 month update Rate response turned off!

by Scotty66 - 2017-04-11 10:02:04

I haven't felt this good for many years. My energy level has improved along with my joy of life! Since having my PM implanted 4 months ago I can once again be as active as I want to be. My PM is like a "best" friend that watches over me!

Just remember if something doesn't feel right with your PM, don't wait 6 months for your next appointment to tell your doctor, tell them NOW!

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