medtronic azure s dr mri w3dr01

Evening all

I would like to go to my first check-up fully up to speed with what options I have on my medtronic azure s dr mri w3dr01.

I was fitted due to bradycardia, a 2:1 block and I think temporary evidence of a mobitz 2 block. I am 45 very fit with no other heart issues.

Before this acute issue my resting heart rate was high 50s.

During running my maximum heart rate was 190. Cycling a fair bit less.

Clearly my aim is to ensure the pacemaker allows me to get back to the same as before.

What are the main things I need to be discussing or watching out for on my first settings discussion?

For example towards the end of my stay in the coronary care unit my 30bpm and moved much higher to high 50s again so if unpaced my heart is now actually back to normal most of the time will they know this and ensure that the lower set point is not too high?

Thank you John

 


6 Comments

Pacemaker options

by AgentX86 - 2020-11-15 18:40:17

There are so many settings that it would pointless to discuss them all here. What you really need to do, rather than become an expert on your pacemaker, tell your EP exactly what you want to do and what you expect.  And listen to what he has to say.  You likely won't get the settings that will allow you to pick up where you left off, at least not right away.  After the initial period, where your heart and PM get to know each other, you can negotiate with your EP for more agressive settings.  He's going to want to change things slowly to see how you do before he gets too agressive.

If you really want to know more about your pacemaker, look it up online.  The features, settings, and manuals are available on line, at Medtronic's site.  Just type "Medtronic w3dr01" into a search bar and go from there.

Take your time and learn well !

by Gemita - 2020-11-16 05:43:07

Hello John,

You do sound all rearing to go!   It is all about symptoms.  If you aren’t having any problems, don’t look for them and assume your pacemaker is doing what it should be doing.  

The best way to test yourself and your pacemaker is to try to do what you normally do, or want to do at least when you are well healed.   If you notice any symptoms like breathlessness, weakness,  chest pain, then you need to keep a diary of when this happens, if it happens for example only on exertion or if it happens also at rest?  These are the sort of things to discuss with your pacemaker technicians and EP.

At your first follow up appointment they probably won’t do too much other than check your wound, your device and leads are working as expected.  They will check for any events like high heart rates or any other worrisome alerts.  At your first check you may not have much opportunity to fine tune the settings which have been set up at implant according to your diagnosis/requirements.  They usually want to see as AgentX86 says how you manage with the settings you have been given before they make any adjustments.  This is just the beginning John and my advice is to move slowly forward and allow your pacemaker and heart to adjust to each other first before rushing in to alter anything.  At first I had tachycardia but slowly it eased without any intervention other than medication adjustment.

A lot of this is trial and error at the beginning.  If you were happy at high 50 bpm heart rate minimum prior to pacemaker implant, then perhaps this is what they have set your minimum heart rate at?   You could try(!) asking the following questions either at first check (6 weeks) or at 3 months when you should get to see your EP.  I would also take the opportunity of confirming what you want to achieve during exercise, so that your doctor will know how to optimise your settings but first read online your pacemaker manual  to see its many functions.  It will be a long read but an enlightening one!

I would try asking for a copy of your pacemaker data downloads so that you can see what is actually set up (your settings).  They may not give you this immediately but you can request it formally in writing under Access to Patient Records. They might if you ask courteously give you a summary page of essential settings, like upper/lower heart rate, % paced in atrium/ventricle, heart rate/arrhythmia alerts, battery and lead info.  With this vital information you will be in a better position to discuss your settings with your doctors, when you have learnt what they all mean.  You can ask questions here too.  Lots of experienced people with knowledge of what works best for them.

 

Good feedback

by quikjraw - 2020-11-16 06:24:32

Thank you Gemita and Agentx86. 

I have written down your points and will also check out the online manual.

As you can tell I am clearly trying to ensure this impacts me as little as possible as I am certain keeping fit and healthy all my life has had a very positive effect on this issue and my Ankolysing Spondylitis. 

I need to stay fit and healthy as I know it will start to cause me problems with my AS.

Thanks again John

 

 

settings

by Tracey_E - 2020-11-16 11:00:18

Once you heal, the pacer should only improve your ability to work out.

First thing to understand is what was normal before may not be normal now so don't go strictly by the numbers. I go by how I feel. If I can talk but not sing, if I'm feeling strong, whatever my rate is, is good. Sometimes it's 120-130, other days it stays over 160 for my whole work out. I only check my rate if I don't feel right. Your resting rate is probably going to feel fast for a while, that's normal and goes away. 

With heart block, the lower setting on the pacer is irrelevant most of the time because our sinus nodes are normal and are setting the pace. All the pacer is doing is making sure the ventricles beat when the atria does and keep the heart in sync. You will probably find that your resting rate is higher than it was before. Before the block made your resting rate artificially low, the sinus node would have kept the atrias beating normally but the signal didn't get to the ventricles so your pulse was low. 

It's normal to take a few tries to get the settings just right. We are all different so they start us out at a good guess then go from there. Upper limit is crucial if you are exercising with heart block. The pacer will make sure the ventricles beat when the atria does, but it can only go as high as it's programmed to go. That's upper limit. They often send us home with that 120-130 so ask where yours is. Ideally you want it 10-15bpm above where you typically get when you work out. I regularly get 175-180, so my upper limit is 190. If you have trouble convincing them to put it that high, or if you get back to exercise and your stamina isn't what it should be, ask for a treadmill stress test. They can watch exactly what your heart is doing and fine tune the settings.

If you had heart block and still got to 180-190 working out, it sounds like your heart might do just fine on its own during exercise in which case the pacer will just sit back and watch. It won't kick in unless it's needed, it will always give your heart a chance to beat on its own first. 

Ask about rate response. This is a feature that gets your sinus rate up on exertion. We usually don't need it with heart block so it can be turned off. Sometimes they leave it on just in case but it can compete with our natural rhythm and cause problems. It can take some experimenting to figure out what's going to work best. I am one of the few that feel better with it on. It senses movement and gets my rate up faster than it would go on its own which is great at the gym. 

Extremely useful

by quikjraw - 2020-11-16 12:29:24

That's extremely useful information Tracey thank you.

It sounds like you have a lot of experience in this area and have been managing your life very well in spite of your issue.

I think I understand most of what you say apart from the lower setting. If all is well but they have set a lower setting of 60bpm will the atrium mounted lead keep me paced? If normal resting heart rate drops below 60?

If so does this not mean my battery will be wasted on maintaining a heart rate just marginally above my normal heart rate when resting or sleeping?

I would like to keep my life as normal as possible but at the same time ensure the battery lasts as long as it can thus avoiding as many replacements in my life. 

Kindest regards

John

 

 

 

more

by Tracey_E - 2020-11-16 13:09:26

Lower limit is for atrial pacing, upper limit is ventricular. Lower limit is usually set at 60 but sometimes they'll put it at 50 if 60 causes problems. So yes, if your own natural sinus rate gets below 60 it will pace. Odds are you won't get below 60 anyway. Before being paced, any time you were under 60 it was probably the block, not your sinus rhythm. 

It's a misconception that how much we pace directly affects how long the battery lasts. It's only one of many things that affect battery life. More important is how much juice it takes to get your heart to respond (once we are healed they set it at the lowest setting that is effective), condition of the leads (yours should be optimal, they're brand new), placement of the leads, how many extra features we use, safety margins.

I pace 100% ventricle, 4% atrial (that's rate response kicking in when I work out). One of my leads is 27 years old and starting to show slight signs of deterioration, I have a lot of scar tissue due to so many years paced, I use rate response. So, not ideal for battery life! My current battery is from 2010 and at my last check it showed 8-9 years left so I'm going to get more than 15 years out of this one. My previous devices lasted an average of 5-7 years. I am on #5. Replacements are a piece of cake. This last time I was home by noon fixing my own lunch then worked a couple of hours. And getting a new one has benefits, we get the newest technology. My first 4 did not have home monitors. Early ones did not go over 160 which was a problem because I get higher than that when I work out, my newest goes to 220 so now I can go work out and not worry about getting too fast. Don't be afraid of replacements. 

Most of us heal and forget about it. There is nothing I want to do that I cannot. No one looks at me and sees a heart patient. I don't keep it a secret but most of the time there's just no reason to talk about it so most people don't know about it. I am very active and high energy (you could say I'm hyper lol) so the look when people find out I'm battery powered can be priceless! This morning, I went to Crossfit class, walked the dog a mile, brought her back then did a 2 mile run. I hike or ski most vacations, love to kayak and do ropes courses and ride roller coasters. I make it my mission to keep the gallery full of fun, active pictures to balance out all of the hospital bed pictures and to show newbies that life goes on, often with more energy than we had before. Block is an easy fix. We don't have a laundry list of other heart problems, we usually have a structurally normal heart so the pacer is a true fix. It wires around our problem leaving us with a normal heart rate. I have a check up once a year, between appointments my home monitor checks in automatically every 3 months. I only know it happens when I get an email from my ep telling me all is well. Every 7-10 years I'm sore for a few days after a replacement. The rest of the time I live my life. It's not going to limit your life.

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