Pacemaker

I had AV node ablation with biventricular ICD/pacemaker placed last week. My Dr. has told me I am 100% dependent on device for heartbeats.  I understand this.  They set the heart rate at 70.  Does that mean the pulse rate will always be 70 or will it increase when I walk or exercise.  I appreciate the help with this.


8 Comments

Good Morning

by Christina Ann - 2020-02-14 09:40:31

Mine is set for bradycardia, so if my heart rate goes below 60 it will send a shock to get it back up. I would think that yours is kind of the same, it will send a shock if it goes below 70, but your heart rate will increase as you do activities, such as walking or running and such. But you can always call the doctor and ask for more detail on how it will work. :)

settings

by Tracey_E - 2020-02-14 10:54:50

70 means it will never let you get under 70. That's the lower limit. Upper limit is how high it will get you so yes it will get you up on activity. 

AV Node Ablation

by AgentX86 - 2020-02-14 11:57:42

I had an AV node (with His) ablation two years ago and also have a CRT (aka biventricular) pacemaker in VVIR  mode. Yes, you and I are "pacemaker dependent".

Your minimum pacing number sets the floor of your heart rate. It will always beat at least 70bpm. You will also have rate response turned on so that, depending on the model, the pacemaker will sense motion and increase your heart rate to accommodate the increase in oxygen required. This process isn't perfect and you'll undoubtedly need your pacemaker tuned to optimize your performance. This is a very personal thing and is highly dependent on your lifestyle. If you're very active, expect to spend some time with your PM technician to get this right.

You say that your PM is set to 70bpm. Did your EP mention that he'll lower this in the next few weeks?  My EP started mine out at 80bpm and had planned to ease it back to 60bpm over a few months. Didn't happen for various reasons but it's normal for AV ablated patients. Instead of lowering mine he set a night rate to make it easier to sleep.

You're asking the right questions.  You need to ask a lot more. The more you know about the geekier side of your pacemaker the better you can communicate with your EP and PM tech to get the changes made to your pacemaker to live the fullest life.

Pacemaker

by marie54 - 2020-02-14 13:22:20

Thanks. AgentX86, the EP set it at 60 when he put in the device. I just didn't feel "right" (can't explain why) and they set it at 70. I go on Monday for f/u. They may or may not adjust again.  After they raised the rate to 70, the Medtronic tech came back and did some sort of "challenge" as he put it. It made me light headed. He didn't tell me what the challange was or that I was being challanged. Have to ask dr about that.  He then came back again and changed the current settings. He said EP wanted to "preserve the battery".  I am not even sure I understand what that means, but will ask the EP on Monday. Thanks for your answers. THere is still alot to learn.

 

Preserve the battery ?

by Gemita - 2020-02-14 13:33:19

Hello Marie54, preserve the battery would indicate to me that your EP is more interested in keeping your battery going for as long as possible than to attend to the comforts of you, the patient.  I would make sure that the rate that has been set is "right for you" not just "right for the battery". Why have a pacemaker if it doesn't make you feel better ??  My minimum setting is 70 bpm and I feel so much better than struggling with low heart rates all my life.

Yes there is a lot to learn but go slowly.  Good luck

70bpm

by AgentX86 - 2020-02-14 14:00:38

The test that made you "lightheaded" was most likely the dependency test. Essentially, they run your heart rate down to 30bpm (minimum they're allowed to go) to see where your heart kicks in.  Since you've had an AV ablation, your normal heart beat can't kick in, so they're looking for "ectopic" beats or an "escape rhythm" (same thing, sorta). There are several places in the heart that can act as pacemakers and the fastest one wins (I'm a normal heart it would be the SI node). They're looking for one that, other than your pacemaker  will keep you conscious. Under 30bpm you probably wouldn't remain conscious but testing further down would be dangerous. The more uncomfortable this test is, the "more dependent" you are.

The "preserving the battery" part was probably an adjustment to the pacing output voltage to align it more with your heart and lead placement. Optimizing this will help battery life as well as avoid some possibly unpleasant side effects.

I'm really surprised that your EP didn't start you out with a higher rate. This was of critical importance to my EP and nonnegotiable for any of his AV ablation patients.

high rate

by SamanthaS - 2020-02-14 15:50:30

I have to have my base at 80 as otherwise the bi-v doesn't kick in with me.  I have cardiac sarc and have the bi-v plus defib for 2 months now.  

Base rate of 80

by AgentX86 - 2020-02-14 23:50:47

Mine is also set to 80 *(daytime) but for different reasons.  I had bigeminal PVCs that were driving me nuts.  My EP had my rate increased to outpace them.  It's worked pretty well but I had problems sleeping with the high rate so he had a night time rate (nominally midnight to 6:00AM) of 50bpm.  It's worked out well.

In our (Marie54 and myself) case, there is no "kick in".  Without the pacemaker there is no pulse.  The pacemaker will inhibit if there is a pulse (e.g. an ectopic), otherwise it paces every beat. The ventricles are isolated from the atria, so there is no pacing signal from the SI node.

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Member Quotes

A properly implanted and adjusted pacemaker will not even be noticeable after you get over the surgery.