Pacemaker settings

My Study showed severe sinus node dysfunction with bradycardia 

mode DDD

Base rate  70

rest rate off

paced Av delay 250

sensed Av. delay 225

max track rate 120

max sensor rate 130

vip on   What is VIP?

ventricular safety standby on

response rate Pvarp/v ref  high

Thanks to this group I learned about RR and tested it out and I go from 70 to 90 just sitting to standing  I never ran a rate over 70 s and 80s before so I think it is too sensitive  Any input is appreciated

i have my 3 month follow up soon and would appreciate a list of any questions I should ask  I am a RN and worked ICU years ago but not cardiac and am knew to this    I am still having pacs but not as many  



30 to 90

by AgentX86 - 2020-09-20 19:21:02

How do you feel?  Are you able to do what you want?  Does the increased rate cause a problem?  If anything is wrong, ask to have it changed.  Otherwise, leave well enough alone.  The whole point is to make you feel better and be able to live the life you want.

VIP (Ventricular Intrinsic Pacing) seems to be a mode where the pacemaker extends the AV delay for some small number of cycles to see if the heart's AV conduction goes back to normal.  If it does, it lets the heart pace itself, otherwise it reduces the delay again.  There's probably another setting that tells the PM how often to do this test.

Increased HR may be good for you for short periods

by crustyg - 2020-09-21 07:12:37

Hi Annie: you ask for comments about your HR going from 70->90BPM when rising from seated.  I think this is probably ideal - you really don't want your BP to fall when rising from seated, as the dizziness and faintness that sometimes accompanies this can be quite hazardous.  And there is *some* evidence that repeated episodes of reduced CNS circulation my increase the risk of dementia.  You must know about cerebral perfusion pressure from your ICU work - it's not great to think of repeated drops in this just from getting up to move around!

If you just stand still after rising from seated and count your HR it should drop back down again, showing that your PM is well tuned.

Most PM vendors have some sort of display / report that shows HR by decade (<50, 50-60, 60-70, etc.) against amount of time your HR was in each range.  I think you will be (pleasantly) surprised just how much of the time your HR is below 80BPM.  It's a really good analysis to check for a) over-pacing, b) patient activity, c) under responsiveness of RR.  Make sure that they show you this report at your check-up.  Better still, take a USB stick/thumb-drive with you and politely and firmly request/demand a copy of *ALL* of your PM settings, reports, data (they can't show you weeks of EMGs - your PM simply doesn't record this), which will include PACs, PVCs, etc.  A goldmine to aid your understanding of what's going on, and particularly useful to keep an eye on your level of PACs.

Once you're more comfortable about what's going on, then you can start to ignore your HR/PM and focus on living life to the full.

HTH - and Best wishes.

Experienced SJM representative and patient

by Carlypollina - 2020-09-29 01:06:04

My name is Carly and I am 25 years old. I got my first pacemaker implanted when I was 13yrs old.  I also worked for St. Jude as a sales rep / technician for the device industry. I have a st Jude pacemaker myself. I used to adjust my own device for this very issue to optimize my workouts.

A base rate of 70 bpm is good base rate for sinus node dysfunction and probably your age. For sinus node dynsfunction VIP should be turned on so that is programmed properly. And your AVDs are set properly too. 

If you are programmed DDD the rate response is not turned on. DDDR would mean rate response is on.

In terms of the rate response it can be too sensitive and make your heart race from even the smallest of movements such as turning over in bed or tapping you leg up and down while sitting.

if rate response is turned on and too sensitive (DDDR) ask the representative to adjust the slope and threshold of the rate response. The slope should typically be under 8 with my previous experience and the threshold should be set nominal otherwise it will be too sensitive. 

BUT demand the rep/technician to let you walk up and down the hallways each time they make an adjustment to the rate response (slope / threshold). You should honestly feel the changes immediately if you are in tune with small changes like I am. 


I would love to help you optimize your device for your next check! I used to work for st Jude and have a pacemaker myself. Not all technicians and reps and even doctors will have your best interest so it is good you are taking on your own education with this. 

If you have any questions please email me at

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