Overpacing

Does anyboody have experience with a pacemaker that paces the heart too fast - ie, significantly faster than needed for the activity at hand and/or faster than the heart is used to?  What are the sensations you have experienced.

I ask because I have swum a mile or more three times a week for over 50 years and also spent several decades on beta or calcium channel blockers while dealing with paroxysmal atrial fib.  The result was an ultra efficient heart,  a resting pulse in the high 40s - low 50s and a maximum rate of 100 while swimming.  Now my pacemaker is set to 100 for most activities.   I find it disconcerting.

Anybody been there, done that?

Thanks.

 

 


5 Comments

Set for 100bpm?

by AgentX86 - 2020-07-04 23:05:49

Certainly that can't be right.  What are the minimum/maximum settings?  Certainly the minimum isn't set to Tachycardia.  You undoubtably had some form of Bradycardia if your heart rate was in the 40s, dipping into the 30s, even with a calcium channel or beta blocker.  Your EP (I assume an EP) raised your rate back to something reasonable and it feels fast to you. 

I was sorta in the same boat.  I went from the high 30s to low 50s to a resting rate of 80bpm, theoretically fpr a month, then back off slowly to 60 (didn't work out that way).  I thought I was racing.  I'm still at 80bpm but it feels normal to me now.

100 seems AWFULLY HIGH

by Protimenow - 2020-07-05 04:03:59

I had my PM because I had Bradycardia - sometimes into the 30s, and I'm NOT an athlete. For me, the heart rate WAS too low. The rate was 50-60 before my arrhythmias nearly killed me. 

My EP set my PM at 70. I've had it set that high for six weeks. I see him on Monday. For me, 70 feels about right, and seems to have blocked (or reduced) one of my troubling arrhythmias. 

I can't imagine a setting of 100. Have you taken your pulse? A reading with fingers to wrist works, but you may want to take your pulse in your neck - it's supposed to be easy to find, and may reveal arrhythmias that you don't feel at the wrist. 

Check your pulse a few times - especially at rest - and you'll have a pretty good idea where the pacemaker has been set.

If it really is at 100, you should ask the doctor why it was set so high. 

pacing

by Tracey_E - 2020-07-05 11:32:53

I'm going to assume you mean getting up to 100 on exertion, not a resting rate of 100.

Just because you got by with a rate so low doesn't mean it wasn't hard on the body. If you are jumping up to 100 on activity, I would say that's pretty low. They usually start it 120-130, and most of us who are active fuss that that's too low. 

First thing to ask your doctor, how are you pacing when you are at 100. If it's ventricular pacing, then your sinus node is setting the pace and all the pacer is doing is keeping the heart in sync. If it's atrial pacing, then that would be rate response on the pacer deciding how active you are and guessing at what it thinks your rate should be. There are different sensitivity levels for this so they can tinker with it a bit to find what works for you. Some settings won't go as high or jump up as quickly when it senses you are moving. 

But my suggestion would be live with it for a while and see if you get used to it, because that number is abnormally low. When I got my first pacer, my rate had never been over 44 (congenital problems) so even a resting rate of 60 felt like I'd been mainlining coffee. Now it feels perfectly normal and I regularly get to 150-160 when working out. It took a few months. 

Thanks for your responses.

by Old_Mainer - 2020-07-05 15:39:17

Thanks for the responses, folks.  I am being sinus paced with an activity responsive pacemaker.  The minimum rate is at 50 to keep low oxygen from waking me up at night.  The Activities of Daily Living rate is set at 100.  The maximum rate with heavy exercise is set to 150.  Activity is measured by accelerometers (like in an I-Phone).  The rate is increased from the minimum to the ADL rate to the maximum with increasing activity.  So far, so good.

The problem seems to be that the rate goes from 50 to 100 when I get up from sitting quietly to walking around the house, washing dishes, etc.  That feels really strange because 3 months ago I was swimming a strenuous 2000 yards in 40 minutes and my heart would be at 95-100.  So washing dishes now feels like a hard swim used to.

I know what my pulse is doing from my pulse-oximeter.  I aso have a Kardia device which (with my I-Phone) gives me a 30 second to 5 minute EKG so I can track changes as they happen.

An ADL of 100 is the default setting for Medtronic pacemakers.  Looks to me that what needs adjusting is the activity level at which the ADL rate kicks in.

If anyone is interested, a full technical description of a Medtronic two lead pacemaker is at:
https://manuals.medtronic.com/content/dam/emanuals/crdm/CONTRIB_260116.pdf  Description of the adjustable parameters starts on page 72.

Giving the pacemaker time to adjust to me and giving myself time to adjust to it makes sense.  I've been thinking (without thinking it through) that what is now is what it will always be.   Obviously that's not so.  But nobody warned me.

Thanks again.

 

sensitivity levels

by Tracey_E - 2020-07-06 09:48:07

They can adjust so it's not as sensitive and doesn't jump up as quickly. Something to think about ... I have mine set very sensitive on purpose. I love it at the gym, my rate jumps right up when I need it to. This means my rate also jumps up walking across the room. There is no one perfect setting, so I choose to live with the annoyance of it jumping quickly inappropriately because I feel it's worth it for the extra responsiveness when I work out. Others may not agree and prefer to live with the lag while working out. It can be changed at any time, so it's ok to give it some time then change your mind later.  

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