Medtronic Azure Upper Sensor Rate - How did the EP get to the number?


I was wondering if the Upper Sensor Rate of your Medtronic PM is set to 100% of your max HR for your age OR was it reduced to, say, 90% or something less of the max HR?


Max rate

by AgentX86 - 2020-10-18 22:19:38

The maximum rate is set more to protect you and depends on why you have a pacemaker.  Your EP may be worried about your heart at high rates right off the bat. Often EPs set it fairly low to prevent Pacemaker Mediated Tachycardia or perhaps even Vfib. Until it's proven that the high rate isn't going to cause a problem you may be stuck with it.  If you need more, it's something you may have to negotiate with your EP.  He may allow it to be increased slowly until he's sure you're OK with it.


by Tracey_E - 2020-10-18 22:42:03

Most doctors don't go by those max HR charts. They're just a guideline and we aren't typical. Whether they want us working out at full effort depends on our health. Just having a pacer isn't a reason to hold back, tho the underlying reason why we have it may be. If our problems are electrical and the pacer fixes what's wrong, pacing is not a reason to force us to hold back.

My settings were done based on a stress test. I'm otherwise healthy, the numbers on my last echo and stress test were solid, so my pacer is set to support me pushing at maximum effort. I have no idea what the charts say is good for me but I'm 54, my upper limit is 190, I regularly maintain 160-165 during a workout. The most I ever get to is 175 or so, so they gave me a cushion over that. I do not use rate response at those rates, it's all me. RR gives me a boost when I get started, then I take off on my own and only need ventricular pacing for my heart block. Not sure if that answers your question, but I don't know any cardiologists/ep's who go strictly by those charts. 

Me NOT EP decided on Upper Sensor rate

by ar_vin - 2020-10-19 00:27:22

As noted above EPs and device techs tend to be conservative in determining settings (for good reason). At implant my Upper Sensor rate was set to a conservative 140. This clearly was not quite satisfactory for my activities. But it took me about four months of recovery and a lot of research (here, other web resources, Medtronic manuals from their website) to push my EP and device tech for more aggressive pacing to support my active lifestyle. Also note that after my initial diagnosis (sick sinus syndrome, sinus bradycardia) and the consequent chronotropic incompetence, I resisted getting a PM. As a result a lost a lot of fitness as I was unable to push myself as much as I had been used to most of my life prior to diagnosis. It took about three months post implant for me to get back to an acceptable level of fitness.

My EP listened to what I proposed (based on Frank's document and my own pre-diagnosis max heart rate etc) and he agreed to let the device tech make the needed changes. My EP was not very concerned with my proposed settings changes. He knew my history of endurance activities as I had (and still have) a ton of tracking data from my Sunnto Ambit3 Peak watch going back months and years in some cases.

But once I had my settings tweaked per Frank's document I saw a quantum improvement in my fitness and ability to sustain endurance activities to levels close to pre-diagnosis.




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I, too, am feeling tons better since my implant.