Pacemaker settings

it takes time

by dwelch - 2018-03-29 01:57:01

It takes time both for you physically and mentally to adjust to the pacer...and you will...like a thumb or big toe you know it is there, but at the same time you wont dwell on it you will mostly forget you have one.

Give it a year to dial this thing in.  A couple three visits.  Your body has to develop scar tissue around the lead which can change the electrical properites.  this just takes time.  You also have to adjust to the new rythm the pacer provides (if yours is more than a one lead/chamber device) and then you can start as needed to inform them of what it is doing, things that may be out of the ordinary for a new pacer patient.

My rate when sleeping was in the 30s before the pacer, they jacked me up to 60 as well, so it took a while to be able to sleep well again.  I think they dropped it to 50 but I am on number 5 and have lived in a number of towns over that time with different docs so at some point one bumped me back up to 60 and that was fine as a lower limit.  I had/have a heart block so the dual chamber smooted it out so much that it was disturbing, to that point I could feel every beat, had the rushing in my ears, etc, didnt have to necessarily put my fingers on my wrist to take a pulse just look at the clock.  That all went away and I felt empty inside.  now this many decades later it is all normal, if I start to feel or hear the pacer it is probably in the safety mode at the end of its life where it locks you onto 60 bpm...and/or something is wrong...

sorry, rambling...if your pacer is there simply to keep you from a low heart rate for whatever reason, in bed trying to sleep is certainly a time where you normally would have been lower, so the pacer kicking in at night when trying to sleep is possible and perhaps expected depending on the reason why you have your pacer.  If a dual chamber then there to smoot things out AND they still have a low and high limit so if you were sleeping at a lower pace it will still kick in. 

correct me if I am wrong but isnt rate response for activity changes, like when you stand up it helps you with some extra beats to cover that activity.  at rest you shouldnt be needing much in the way of rate response.  your body already does this and if it is driving the rate (above 60 and below your upper limit) then the pacer just follows that to the second lead (if you have one and based on your heart issue(s)).

Although more and more they are touchy about this, but as far as I am concerned it is MY data that I have permitted them to have not the other way around.  Every time you go in and at some point where they are finishing up and printing a report for the doc, tell them that you would like a printout as well.  Each brand has a different term like summary report, etc.  But there are reports (I have had medtronic, st jude and now boston scientific although there are only a couple of brands of machines as these companies are buying each other up) that will show the current state and any changes or the medtronic one would show basically what the settings were when you started the test and when you finished and highlight changes if any.  Whether you have rate respons on or not would be in that report in whatever form that box/software prints it.  

My current doc (about 13 years now) the routine is nurse/tech does the test, then wonders off and the doc comes in after seeing the report, etc.  I have my copy the doc has hers, if I have any questions about the report I ask then.  Seem to remember that is the routine for all the docs, my first pacer doc did the test himself, no tech/no nurse...Didnt know to ask about printouts at that time and there was a LOT less data/info back then, pacers didnt tune themselves, etc...wore holters on and off that first year to get the thing dialed in.

Ignore the battery life estimate on the report...just ignore it...it is usually a bad estimate.  When it says you have a few weeks left, okay you can talk about it then, but the doc will bring it up first at that point.  Sadly insurance companies are pushing the docs to ride the pacer into the safety mode (whatever term they use, locks you at 60bpm, which you definitely feel when trying to climb stairs, etc).  I dont know what they think they are saving, a few months at the end of a pacers life that has lasted for several years, even in my case where I started at 19 years old, a few months per pacer is not going to save them a whole pacer in cost.  Maybe its a case of for tens of thousands of patients if we can extend their pacers a few months each that saves us a few hundred pacers being consumed.

short answer, yes at rest, your body slows down as does your rate thus a "resting heart rate", so if you are going to hit your lower limit that is when you are going to hit the limit, sitting down to rest or trying to sleep.  Rate response is for physical changes like standing up, transitioning from walking to running, etc.  If you had a low resting heart rate before you are going to have to deal with a lower limit, may have to learn to fall asleep again.  You can ask them to lower your limit, they may or may not choose to do that for you.  Ask for your copy of the report every visit/test, the final settings should be printed (including rate response on or off).