Does a PM sense simple motion like a bumpy road??

Hello to all of my fellow pacers! I just had my PM surgery last Thursday after dealing with second degree AV block and my heart rate dipping into the 30's on a regular basis. After the PM install, I'm doing pretty good and my rate is staying above 60 now. So here's my question, which is about how the rate changes when needed. I've read a bunch and realize there's tuning that will have to be done to get the rate to increase and decrease according to my needs, but here's something odd that I've noticed that has me concerned... my rate appears to increase with any kind of motion, including going down a bumpy road. I was out a few days ago on my Corvette, which rides pretty harsh, and my rate went over 100 many times, which freaked me out, especially since I was just relaxed and enjoying the ride. Then today I was out in a more normal car and noticed that my heart rate on those same roads was much less, but when I went over some stretches of rough road, my rate would increase instantly. This seems a bit concerning to me with my rate going up when I really don't need it to. Do these devices really sense motion like that, and if so can you request to have that type of sensing toned down or better yet turned off?? Seems like it should be relying on your breathing rate or something like that. Any input would be great!! Tim


Wonders of rate response!

by ar_vin - 2020-05-05 18:28:17

Welcome to the club you never wanted to belong to!

Yes that's the wonderful rate response feature of your PM working to raise your heart rate in response to detected movement. Just not the movement that you need it to responsd to but there's no way to tell your PM that unfortunately.

I felt the same rise in HR that you describe while driving over a bumpy stretch of road and was quite uncomfortable at first. Eventually you'll get used to it.

It's still early days for you post implant so take it slow and let your heart and body adapt to being paced and to heal from the trauma of surgery. It does sound like you're recovering well!

Depending on your activity level you'll need to go back and have your PM rate response settings adjusted. It might take a few different sessions over a few months. Please educate yourself and ask questions both on here and of your EP before you go to your appointments for getting the PM tweaked. The device techs and EPs tend to be conservative (rightly so); they need a bit of persuasion to have them do what you need done. The better informed you are, the easier the conversations will be and more importantly you'll get the settings you need for your lifestyle.

Good luck on your adventures and please do report back!



by tapeterson - 2020-05-05 18:47:03

Hey that was great input, and yes it's definitely a bit unnerving to have the rate increase when I'm really not doing anything but cruising down the road. Hopefully when I see my EP and device tech next Tuesday, I can get my first adjustments. I surely will be asking about the rough road thing LOL! Thanks again for the very helpful and speedy input! Tim

Bumpy road ahead

by AgentX86 - 2020-05-05 21:44:10

Note that if you have the "bump sensitivity" turned down, it will also decrease your rate response to exercise.  If you're a couch potato this might be OK.  OTOH, if your an active type, it wouldn't be good.  You'll likely have to find middle ground or get used to an increased rate.

Other vibrations

by Theknotguy - 2020-05-05 23:10:22

There are other things to which the rate response will respond.  Like AgentX86 said you may want to keep the rate response up in spite of it being  inconvenient at times.  

The spouse and I were taking a bus tour and I couldn't sit in a couple of seats on the bus because of the vibration.  I also volunteer in a charity woodshop and I picked up a Saws-All reciprocating saw.  Forgot about my pacemaker.  When I turned it on and pressed down hard the vibration  kicked off my pacemaker.  I also work at a charity and ride in their large trucks.  When they're empty they bounce around a lot and that will kick off my pacemaker too.  The running joke is it looks like I'm giving the drivers a Roman salute.  I'll reach over with my right hand and hold it over the pacemaker to stop the vibration.  

Hope your adjustment to your pacemaker goes well.


by tapeterson - 2020-05-06 08:00:10

After reading about the saws all vibration I have a feeling that my issue wasn't so much the bumps in the road but the vibration in that car. The exhaust is very loud and the engine is very high performance and shakes/vibrates a bunch... kinda like a saws all under your butt LOL! I'm definitely going to have to have that feature toned down because I wasn't even driving the car hard, plus I do track events with it and will hopefully be back doing those soon! 

rate response

by Tracey_E - 2020-05-06 10:58:12

Yep as the others said it sounds like the car is activating the rate response. They can turn down the sensitivity, but if all you have is heart block ask them about turning rate response off. With heart block, in theory our sinus rate is normal so we don't need atrial pacing. All we need is the pacer to kick in and make sure the ventricles keep in sync with the atria. Rate response, which is atrial pacing, is there for if the sinus rate doesn't goes up normally on exertion. 

To Tracey

by tapeterson - 2020-05-06 11:24:00

Yes that's what I have and I was told that my sinus rate was cruising along as it should but not making it past the AV. So yes I'm hoping that maybe I can either turn that feature off or at least change the settings so it's not so sensitive. It's definitely going to be the hot topic at my first follow up visit with my EP and device tech.

rate response

by Tracey_E - 2020-05-06 11:45:23

If you don't need it, it's better to turn it off altogether. It can compete with your natural sinus rate, and it will use up your battery faster. If it turns out you need it, they can always turn it back on.

Mine is on and I do use it, which is unusual for heart block. Opposite of you, I had to ask to have it turned on when I got my newest one (I'm on #5) because my doctor automatically turns it off for av block patients. 

Rate Response and Vibrations

by Marybird - 2020-05-06 19:04:54

I'm an old lady ( 72) with sick sinus syndrome ( tachy-brady), and I learned the value of the rate response feature on my pacemaker ( St. Jude Assurity Dual Chamber model 2272) after the EP turned it on during my six week post implant checkup. It had been off for the 1st 6 weeks, and though I was feeling better I was disappointed that it seemed my heart rate still didn't go up all that much when I exercised or with activity. I recall wondering if the rate response was on, but tbought it had to be, and I was such a newbie I thought maybe it was just something I needed to get used to.

Once that rate response was turned on, I really noticed the difference- felt much better, with more energy as my heart rate went up to match my every day activities. 

Even with that, it seems my heart rate doesn't increase as much as it could when I exercise, ( about 40 minutes/day 6x weekly divided between elliptical and recumbant bike as baseline exercise), and it's hard to finish it sometimes. I've thought of asking the EP/pacer tech about turning up the rate response to accomodate the exercise, in fact, we talked about this at my last EP visit.

We decided against doing so-they left it up to me, but agreed with me when I shared my thoughts about it. What came to mind was those "vibration" rate responses, which for me happens with trips taking the "back way" home, a bumpy two lane road, especially crossing a river on an old bridge. It also happens when I flip over onto my right side at night, and when I rock in one of the rocking chairs on our patio. At these times my heart rate goes up to around 100-110, and back down quickly when the activity stops. Those are about the only times I notice that type of increase, and I know it would occur more often if they increased the rate response. What I don't want is to experience that every time I bend down, make a sudden move, or whenever. 

It seems the current setting for the rate response is very much adequate for my everyday activities, and I can live with those few times the rate response drives the heart rate up when I flip over in bed, etc ( especially when I know what's happening). If I can't get my heart rate up as much as I'd like when exercising, it's,a small tradeoff. I'm  certainly no athletic whiz, so I will live with it.

So as I said to the EP and pacer tech, "welp, when I become a marathon runner or a triathlete, then we can turn up the rate response. And that'll be maybe....when the cows come home!". So until then, it's good where it is. 

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