ICD combo

One day in 2011, I fell down on my kitchen floor, the EMTs took me to the hospital and I was diagnosed with Bradycardia ( slow heart rate), they implanted a St Jude’s PM and discharged me next day. For almost eight years I didn’t have any problem until in October of 2018 when I almost blacked out sitting in the passenger seat of my car. I called my primary physician and he told me to go to the ER, there they interrogated my PM and found that I have Tachycardia (fast heart rate). Doctors told me that I needed an ICD instead of my existing PM. So after a week in the ICU they changed my PM and implanted a combo( ICD plus PM). It has been six months and I was shocked once and was hospitalized again. This time they adjusted my settings and made it to 100% pacing. Now, when I walk on a treadmill and use a stationary bike my HR remains at 60 witch is the base rate of pacing but when I do some walking on the street or park, my HR goes up significantly. Also, when I do some household chores my HR goes up right way. I don’t understand the consequences of 100% right ventricular pacing. Any help out there to understand these issues. Really appreciate. Thanks 


Not a lot of information here

by AgentX86 - 2019-05-02 21:46:09

It appears that you have chronotropic incompetence (your sinus node doesn't respond to the body's need for oxygen) so you rely on your pacemaker to guess when you need more O2.  Your pacemaker senses motion and from that it deduces when your heart rate needs to increase (called "rate response").  However, it's not sensing the motion on the treadmill or exercise bike so you're stuck at the minimum rate.  Apparently it's working OK for normal exercise, so the PM is working and rate response is enabled.  From these guesses, I would presume that you need the sensitivity of the accelerometers in your pacemaker increased,  Your PM tech can do this pretty easily but it'll likely take a few tries to get it right.  You should have no trouble on the treadmill but the exercise bike may be a continuing problem.  Your torso doesn't move much when you're on (any) bike so your pacemaker probably won't pick it up.  If you have it set sensitive enough to detect this motion, it'll probably be too sensitive for normal daily activity.  This is a tightrope that you'll have to walk if you want to use these exercise machines.

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