Getting Back to Running

Hi all.  I am a newbie, with an implant date of 7/18/19.  Sick sinus syndrome, bradycardia...with very mild heart block.  I have a Biotronik Edora 8 DL, that is set at 50 lower level and 160 upper level.  i am 59 years old and have always been a recreational runner (mostly 10ks and 10 milers) biker, and swimmer.  So far i feel great!  However, I have a couple questions for anyone who might be able to help:

1.  When i run, my heart rate goes up after a couple of minutes to 160, the max, and stays there for the duration (i had this increased from 150 recently).  The running feels good (big change from pre-implant!).  Are there downsides of increasing the ceiling to 170?  Upsides?  My target HR is 160.  Doc leaves it to me, depending on to how i feel.  Any shared experience would be helpful. 

2.  Swimming.  I have not been in the water yet.  I was cleared by Doc at one month, but was told by pacer technician, to be cautious, wait 2 months.  I am now at 2 months, but still a bit tentative.  Any swimmers out there that can alleviate my concerns?

 Thanks everyone.  I really appreciate this site!



by Tracey_E - 2019-09-11 21:35:21

Welcome! Glad you found us and are feeling so good.

Ignore those target heart rate charts. We are paced, they do not apply to us. If you feel strong, if your stamina is good, if you can talk but not sing, then I wouldn't mess with it.  

You can swim now! 2 months was very conservative. My doc said stay out of the water (infection risk) for 30 days, watch the long strokes for 6 weeks.  Take it easy as you start, work up to the distance you did before. If you feel sore around the pacer after, ice it.  

Max permitted HR

by crustyg - 2019-09-12 04:23:14

Hi: I am also a runner (and cyclist and swimmer), although I no longer compete at running, having moved to Pilates - don't laugh, it's good for the core, and core is what connects the pelvis and leg muscles to the heart and lungs - and I'm older than you!

The increase I negotiated up to 160 (and now that I'm atrial paced 100% of the time so have proper A then V sync) dramatically increased my max heart output, so my legs felt *fantastic* when running and cycling up hills.

160 or 170? Well it depends.  Conventional wisdom is 220-age in years for max-HR, so 170 or so might make sense.  I cycle with a lot of younger folk in warm, hilly country and hardly anyone exceeds 180 - and some of them are in their 40s.  So if your coronary arteries are good and clear 170 might well be ok for you.  You will need to make the case quite carefully for your EP doc to allow that!  They are very nervous for adults once we ask for 160 or more, in my experience.

Long term high heart rate is known to be bad for the heart - but I mean *long* term, hours at a time for days on end (i.e 6 months with atrial flutter).  Even if you do a full marathon (4hr for you?) that shouldn't be a problem at 170.  But if you start to have chest pain - heart chest pain, not PM pocket) then SLOW DOWN.  No-one can tell you what it will be like.  The biggest risks are a) your heart muscle runs out of oxygenated blood - coronary disease, b) you push your heart muscle into some abnormal rhythm - Afib is the commonest and will impact your heart output, but V-tach is possible and a lot more serious...  As you have some heart block there *may* be some evidence of coronary artery disease, I can't tell.

*IF* you have some heart rate data from before the SSS/brady took over it may help your negotiation - 'look, doc, only 2 years ago I was running with max HR of 174' is easier than 'please may I have my max HR raised again to 170'. 

Swimming: you may find that you can't get your HR up to what you need for good, fast front crawl (or 'fly).  There's not a lot of movement for the accelerometer to use for swimming and Minute Ventilation is not helpful for swimming, so you may need your response factor increased for swimming.  Tuning your PM box to you is very individual and depends a lot on what you want to do - in your case exercise for fun!

Hope that helps.

heart block

by Tracey_E - 2019-09-12 09:33:10

heart block is electrical and completely unrelated to coronary artery disease, it's when the electrical signal gets blocked and doesn't make it from the sinus node to the av node. The pacer fixes heart block, that's the ventricular pacing. 

If you want to try 170 and your doctor hesitates, ask to do a stress test. They can get you on the treadmill, watch what the heart is doing, and make adjustments to the pacer. Saves a lot of time coming back! That's how mine was fine tuned.

Running with PM and SSS

by CyborgMike - 2019-09-12 23:32:24

I also have SSS, bradacardia, and a condition called CPVT, which is an exercise induced arythmia, but I love running, so I've worked with my docs to tune my PM as best possible. I'm also taking a low dose beta blocker for the CPVT, which pushes my top rate lower.

For me, we had my max at 140 to stay out of the CPVT danger zone, but that was really hard to run any type of incline. We increased it to 150, but realized I was V pacing when running hard. My EPs were awesome. I would upload to Merlin manually (clearing the baseline), go for a 3-4 mile run, then upload to merlin again. The EPs could then look at how much V pacing I was doing on the run vs. normal activity with no run. Ultimately, they diagnosed me with rate induced AV block (a side result of CPVT), indicating the faster the heart rate the more AV block I get, so the PM needs to fire a pulse to the ventricles. For me, they agreed that leaving it at 150 and running 2-3 miles a day was OK. The overall V pacing was still low (<5% overall). I would love to be at 170 (220 - age), but that won't happen for me. Everyone's situation is different. One note about rate response... The PM sensors are very limited. They primarily use an accelerometer to gauge activity. So, when I start my runs I have a long easy downhill for half a mile, I'm running brisk, but easy and the RR pegs the HR to max (150). When I turn around and run back up that long hill I am going slower and huffing and puffing to get air, so the RR thinks I am going slower and easier and drops down to 145, when really I need as much pumping as possible. Tuning can help, but over tuning will have the PM pegged when you jump up to go to the bathroom. 


by Pacedmyruns - 2019-10-01 03:32:47

Great info. I have exercise induced heart block. So I Pace 100% with exercise in my V lead too. Mine is rate dependent too. I'm going to look up CPVT. When you say your pacing is 5% is that with exercise only or all the time? Mine is high even tho I only need pacing with exercise. I'm at 48%. 

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It may be the first time we've felt a normal heart rhythm in a long time, so of course it seems too fast and too strong.