New CRT device on 11/11, lower rate set at 90?

So I am home from my sternotomy mitral repair where they also added a third lead and swapped out dual chamber for crt.  The day before I left the hospital ( 4 nights ago) I found out they have my lower rate set at 90.  They said this is normal and they will lower it later but my next follow up isn't for 30 days.  Is this normal? It is very unpleasant especially since I have svt I am waiting to have abated so I am almost always tachy now.


6 Comments

90 bpm is still a normal heart rate

by Gemita - 2020-11-23 09:45:22

Assully, 90 bpm would still be a normal heart rate. (Normal heart rate is between 60-100 bpm and tachycardia above 100 bpm).  I am assuming that your doctor is controlling your SVT rate with medication, so if your heart rate is kept under 100 bpm and hopefully closer to 90 bpm, you should be okay.  Are you getting higher SVT rates than 100 bpm?  If so, you could speak to your doctors and ask whether your medication might need temporarily increasing or even whether your heart rate could be dropped slightly to 80-85 bpm?

I do not know what your lower heart rate was set at before your third lead.  If it was around 60-70 bpm, you are bound to feel the higher minimum setting of 90 bpm, especially if your medication is not controlling your SVT.

I cannot help you on why this higher heart rate setting is required for up to a month following CRT.  Perhaps you should call your pacing clinic and ask them to explain why?  You have had invasive surgery, so perhaps the higher heart rate is to give extra support to your heart during the healing process.  (Did your EP by chance mention they wanted a higher heart rate to try to outpace some of your arrhythmias?)  I note this was tried in the past.  I would speak to them for help if you cannot tolerate 90 bpm.

I hope you recover well 

90 bpm

by AgentX86 - 2020-11-23 15:44:15

Yes, this is quite normal.  I didn't much like 80bpm after years of 50bom, or lower so asked about this when I had mine implanted. The explanation was that there is a higher than normal instance of SCD after a CRT implant.  A higher rate avoided this problem (they don't know why, evidently) so they start out high, then adjust it downward to "normal" slowly.

In my case, as soon as they dropped it to 70bpm I started having PVCs so raised it back to 80bpm and left it there.  I got used to 80 rather than having to put up with PVCs.

Thanks AgentX86

by Gemita - 2020-11-23 16:28:53

for the explanation on higher heart rate setting following CRT implant.  Strange they cannot answer why and how it provides protection from sudden cardiac death.  I would like to see the evidence.  

Higher heart rate after CRT

by AgentX86 - 2020-11-23 23:33:17

Franky, I've never looked for documentation.  This was my (rather well known) EP's explanation of my increased heart rate.  His strategy was exactly the same as ASULLY's doctor's.  High for 30days, then backing off 10bpm every 30 days after. I don't think it was known  (or he claimed not to) but it was found to "eliminate" the problem.

Never got a direct answer just the usual “that’s just how it’s done”

by asully - 2020-12-14 01:33:29

Still stuck at 90 as my lower but discovered it doesn't matter, my heart rate hasn't dropped below 100 bpm since my mitral valve replacement and crt/3rd lead insertion.  Luckily I was cleared for my ablation which was delayed due to the valve surgery and right sided HF complications that followed. Originally the ablation was scheduled a week after the sternotomy but they decided my heart needed 4 weeks.  I am actually really happy to get the ablation because while many of my valve related HF symptoms have gone away my SVT symptoms are worse.  My lower rate before CRT was 50 I believe, not that low has been a problem for me ever because of my fun little SVT, but I am used to a resting heart rate of around 70 when fully resting and the arrhythmias are not acting up, after a month straight running over 100 I am ready to get slowed down.  As for meds, I can't take them.  My blood pressure is waaaay to low, average 90/50-60 (depending on if I have taken my diuretics for the day.  My HF doc is going to start me on digoxin, he says it may help my heart rate and possibly help with reverse remodeling (since I can't take ace or arbs either).  Aside from diuretics (which are problematic but absolutely necessary, I retain a ton of fluid) I can take any of the guideline directed medical therapy meds, we have tried when things would get bad but the cost outweighs the benefits in my case unfortunately. I am hoping my ep will adjust the pacer settings following my ablation in the AM, I haven't received much information from them on how they plan to sort it all out.  Just crossing my fingers ablation goes well and isn't terribly painful, although considering I just survived my second sternotomy in 5 years I think I can handle the ablation with style.  Thanks for the responses, glad to know my EP wasn't crazy and running me high for no apparent reason, it just seemed so counterintuitive when dealing with an already weak and healing heart.

Never got a direct answer just the usual “that’s just how it’s done”

by asully - 2020-12-14 01:33:30

Still stuck at 90 as my lower but discovered it doesn't matter, my heart rate hasn't dropped below 100 bpm since my mitral valve replacement and crt/3rd lead insertion.  Luckily I was cleared for my ablation which was delayed due to the valve surgery and right sided HF complications that followed. Originally the ablation was scheduled a week after the sternotomy but they decided my heart needed 4 weeks.  I am actually really happy to get the ablation because while many of my valve related HF symptoms have gone away my SVT symptoms are worse.  My lower rate before CRT was 50 I believe, not that low has been a problem for me ever because of my fun little SVT, but I am used to a resting heart rate of around 70 when fully resting and the arrhythmias are not acting up, after a month straight running over 100 I am ready to get slowed down.  As for meds, I can't take them.  My blood pressure is waaaay to low, average 90/50-60 (depending on if I have taken my diuretics for the day.  My HF doc is going to start me on digoxin, he says it may help my heart rate and possibly help with reverse remodeling (since I can't take ace or arbs either).  Aside from diuretics (which are problematic but absolutely necessary, I retain a ton of fluid) I can take any of the guideline directed medical therapy meds, we have tried when things would get bad but the cost outweighs the benefits in my case unfortunately. I am hoping my ep will adjust the pacer settings following my ablation in the AM, I haven't received much information from them on how they plan to sort it all out.  Just crossing my fingers ablation goes well and isn't terribly painful, although considering I just survived my second sternotomy in 5 years I think I can handle the ablation with style.  Thanks for the responses, glad to know my EP wasn't crazy and running me high for no apparent reason, it just seemed so counterintuitive when dealing with an already weak and healing heart.

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