Follow up to: Long term effects of more sensitive rate response PM settings


I posted an update to my original post; since it doesn't show up on recent posts I thought I'd post a pointer here.

Check the original post at link below.

Hope it helps!



Higher rate

by AgentX86 - 2020-10-15 23:33:03

A long term rate above 100bpm is asking for cardiomyopathy.  If it's going up that quickly, I'd be worried about the time spent above 100bpm.  Your cardiologist/EP should know what they're doing though.

My RR is turned to ramp fairly quickly, too.  I've never seen it above 113, so I think my EP has put a tight lid on it.

Rate > 115

by ar_vin - 2020-10-16 03:30:58

I have a long history (30+ years) of endurance activities (running, hiking up big hills/mountains) some times for 15-20 hours at a time (or even longer). During these activities my heart rate would exceed 130 for hours at a time. This was all pre pacemaker implant and before  any symptoms or diagnosis of sick sinus syndrome in 2017.

My EP simply pointed out that given my history the PM pacing me over 115 is not special for *me*. His only suggestion was to allow my body and heart to recover adequately after each hard effort.

Two weeks back I went on a multi day backpacking trip in the Sierra - each day I was hiking 8-10 hours with a 35+ lb pack gaining 2000-3000 ft of elevation. My starting and ending elevation was around 6800 ft and I spent more than day over 11000 ft. My heart rate ranged between 115-125 while I was moving,.


I'm hardly alone in this world of endurance activities. I know folks that regularly run 100+ mile races in the mountains and they have done it for years. Same thing with cyclists, triathletes, swimmers, ski mountaineers, mountaineers and on and on.In fact I barely even begin to approach the intensity or duration of activities of most ultra endurance athletes.

Dr John Mandrola, a well known EP,  himself an endurance cyclist has documented his personal struggle with AFIB. He has chosen to step back from hard, long bike rides.

Many of us who pursue these sports feel like our hiking, climbing and other outdoor activities very much define who we are and would be unwilling to give that up as long as our hearts and bodies allow us.



Sustained higher heart rates

by Gemita - 2020-10-16 05:51:53

Hello ar_vin,

Thank you for the update.  What a truly inspiring post and thread.  I can see you have a very helpful relationship with your EP who is taking good care of you but at the same time not holding you back.  I don’t suppose anyone ever could and that is why you are doing so well.

A lot of what you say is relevant for you as a life long active person who has always pushed the boundaries and I appreciate your comments might not be “so relevant” for those of us who have led quieter lives.  But nonetheless it goes a long way to reassuring me that a more sensitive rate response PM setting may be “safely” possible.

Although I am still able to exert myself when I have to, having been active all my life, I no longer do regular exercises (I know I must address this) due to Atrial Fibrillation.  Fortunately my AF is still intermittent but when it occurs, it is quite difficult to comfortably do anything too vigorous, or sustain a good level of exercise.  Yesterday while in AF I decided to ignore the quivering and a slowish beta blocker controlled heart rate not hitting much above the 120s bpm range and attempted to do some dancing routines.  It was neither possible nor comfortable and I was forced to abandon my attempts.  Chest pain, mid central was building up and only relieved by stopping my routines.  Such a pity since I needed the adrenaline rush after the day I had yesterday being in AF for hours (unusual for me).  

When I last saw my EP I questioned how long I could safely sustain a higher heart rate before it might adversely affect me.  Maybe he was trying to reassure me but his response was somewhat surprising, rather like those of your EP ar_vin, that because I have always been active and have a strong heart with no signs (yet!!) of cardiomyopathy or scarring, I could manage days if not longer of sustained higher heart rates without causing any harm.  Not sure that I would agree, especially with AF being the main cause for my intermittent higher heart rates and the adverse symptoms I am clearly getting when I try to ignore my AF during exercise, but there you are.  Clearly I need to go back to my EP for further discussion, but your post has been most reassuring.  Thank you

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