Optimizing settings

I will actually see the EP doc in two weeks, 5 1/2 months after implantation. I plan to ask my settings be optimized for exercise. I have also started running, and will be cycling when the weather gets better. I have a BiV CRT because of persistant bradycardia and an EF of 50%. The rate settings are 60-130, which Ipresume are the default settings. When I run/jog, my HR gets to 130 and my Garmin watch is calculating my VO2 max at 28, which gives me a fitness age of 69. As I am only 62, I would like to improve on this. 

My questions are: will raising the upper limit increase my VO2 and or fitness level? Or do I just need to keep training? Or am I too old and fat, and just a lost cause? 


Well past the time to have your PM tuned for you

by crustyg - 2020-01-05 12:21:44

IMHO you should had your PM tuned for your requirements months ago - but now is a good second place.

Short answer is Yes - well almost certainly, assuming your lungs are OK. 60/130 is indeed pretty much manufacturer's default.  Increasing your maxHR should increase your heart's blood output which will allow your muscles to extract more O2 per unit time - VO2-max.

When it's all adjusted properly the blood vessels to your mucles, your muscle size (of the exercising groups), your lung gas-exchange and heart muscle performance should be tending towards their best performance at much the same level.  My guess is that your maxHR should be more like 160-170bpm for your age - if your heart muscle health can handle it.  All other things being equal this will deliver a *lot* more oxygenated blood to your muscles per minute, so you'll be able to do more.  You may notice an *instant* improvement in your exercise capabillity, but this isn't guaranteed.

Once your cardiac output is no longer artificially limiting, then your training efforts should result in fat burn, lean muscle growth and a wonderful endorphin-rush after serious effort (we older folk know that it's really just smugness, but it feels fantastic whatever the name!).

Best wishes.

PM tuning

by Julros - 2020-01-05 13:27:30

Thank you Crusty for the info! Regarding earlier tune-ups, my LV lead took some time to fix in to place, so I believe the focus at interrogations has been on assessing and adjusting for capture. Also, I was having a great deal of pain at the site up until December, so I only recently started running. 

I was not told to make a 3 month appointment, so when I got an email to tell me it was due, my upcoming appointment (6 months post implant) was the soonest they could get me in. I sort of threw a fit just to be able to see the doc and not the NP. 

My lungs are in good shape, my stress test was normal, as was my echo, other than an EF of 50%. So I am ready to take things up a notch! 

Makes sense

by crustyg - 2020-01-05 19:05:01

Thanks for the additional info: I hope it all goes well for you after the tune-up!

New settings!

by Julros - 2020-01-16 01:34:38

The EP doc increased my upper rate to 140, which he thought was suitable for my age (62), and he did increase the sensitivity, so hopefully it will kick in when I ride my bike up hills. He was quite surprised at the amount of site pain I had for as long as I had it(5 monthss), and suspected I may have had an atypical infection. Now I just need for the snow to go away so I can go for a run and try out my new settings. 

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It made a HUGE difference in my life. Once I got it, I was finally able to run, and ride my bike long distances.