Another upper rate question.

My upper limit for exercise would be 116. I have a Biotronik 2 lead for Sick Sinus and Brady/Tacky since 11/20.

My HR is set at 60/120. I'm moderately active. I routinely go to 128 walking as I do two planned steep hills as part of my walk. I knew my heart had to be doing the 128 on it's own.

Prior to my implant, I was unable to walk more than 10 min. at a time, achieving 85-90BPM.  I have a history of walking many years and running 10 years. My only heart problem is electrical, I follow a vegan diet and I move throughout the day.

Is exceeding the upper limit during daily walks a problem? What advantage would asking to be increased to 130, or even 140, upper achieve? 

Thank you!


A treadmill test ?

by Gemita - 2021-05-16 15:59:09

Hello Pharnowa,

My upper tracking rate is set at 130 bpm, so is the sensor rate and I do struggle when I exercise sometimes but because I have tachyarrhythmias I feel my EP is reluctant to increase these rates.  I need to discuss this with my EP too.  Your 120 bpm upper rate does seem a bit low.

I believe our pacemakers can differentiate between a higher heart rate caused by say an arrhythmia and a higher heart rate caused by exercise, although if you do have arrhythmias, it may start to monitor you when you approach 120 bpm to watch for any electrical disturbances which might require control and this could affect your ability to exercise.  For this reason I would imagine raising the upper tracking rate would certainly help you to continue exercising without restriction.

I think it would be very helpful Pharnowa if you were to ask for a treadmill test and they could then assess you fully and make sure that your settings are optimised for you and any increase in upper tracking rate will be safe for you especially if you suffer from arrhythmias.  A treadmill seems to be very popular with many members of the Club and really is the best way to get answers to our many questions.


by AgentX86 - 2021-05-16 16:20:13

Along with SSS are you CI (Chronotropically Incompentent)?  If you are, yes, your heart probably can't increase its heart rate on it's own and is relying on your pacemakers rate response to increase your heart rate.  In that case, you would need to have your upper limit raised.  If your only problem is SSS and Brady/Tachy you stand a good chance that your EP will allow it.  60/120 is quite low if your only problem is SSS.  BTW, the Brady part is why you have the pacemaker.  The PM isnt going to do anything about the tachy part.

If, however, you're not CI then, above the resting rate, your heart rate is being set by your sinus node and there is something else going on.


by Persephone - 2021-05-16 18:44:14

Hi Pharnowa - I have a biotronik device also, since 2018.  Also couldn't walk much just before my diagnosis and implant, vastly different from the ability I had before symptoms arose.  After implant, I had to request a stress test (treadmill) with the biotronik rep present to help with my ongoing SOB that continued, albeit to a lesser extent, into the 2nd year.  The adjustments that were made that day made a world of difference for me, and I hope you can find similar assistance from your medical team. 


by Pharnowa - 2021-05-16 20:08:22

I haven't been told I am CI, Agent86,but prior to the implant I couldn't seem to get above 90 HR, except, of course, when tachy. Can that improve either with the PM or from generally being conditioned again? I know the PM doesn't help with tachy. Can't the PM set at 120 mean if my HR goes to 128 on a hill (exercise) it means that my own heart is doing it? I feel ok when it happens. 

Persephone and Gemita,  I will ask for a stress test with the rep. I do have periods of SOB but they seem to be non -exercise times such as getting up from sitting and going to another room. During exercise, I can feel winded but it seems appropriate. I have not caught lowered BP at home I'm inspired to know things can be a improved even after time goes bye. : )

Thanks for your responses!


Getting up from sitting

by Persephone - 2021-05-16 22:14:40

Just to add, Pharnowa, when I also continued to have problems with rising from a seated position to standing, this was the trigger that led me to seek help.  I could do most of the exercise-related stuff OK (maybe not that well, but good enuf) but I had to be able to function at work and so finally sought some help.


by AgentX86 - 2021-05-16 22:40:39

Yes, if your heart goes above the maximum rate, it would seem all you (tachy or exercise).  OTOH, if you couldn't get above 90 before, it suggests that you are CI.  This is confusing, at least to me.

Feeling SOB or dizzy on standing is very common.  It's caused by a drop in blood pressure when you change position.  When you stand, you need a higher pressure to get the blood to the brain but there is also more blood that wants to go to the feet.  Often the heart can't do both so pressure drops momentarily and you feel light headed.  This is known as orthostatic hypotension.  The most common advice is the old "don't do that".  ...stand more slowly.


by Persephone - 2021-05-16 23:00:12

The adjustments I had to my biotronik device (essentially turning on RR and perhaps some other miinor tweaks that I wasn't provided details about) have allowed me to stand from sitting at whatever speed I desire without feeling faint.  Just my experience. It's worked for me for the past 2 years and I hope it will continue to do so for at least a bit more :)

Orthostatic hypotension.

by Pharnowa - 2021-05-16 23:20:05

I have taken my BP a couple of times when this happened and it wasn't down from usual 120-130/70. I drink water also and take a kardio. It doesn't happen every time but it's troubling when it does.

My RR is on and I thought maybe rate increases too rapidly. It's puzzling.

Thanks again!

Orthostatic hypotension

by AgentX86 - 2021-05-17 00:39:50

A BP cuff isn't going to show orthostatic hypotension.  It happens too quickly to register on a normal BP cuff.  RR doesn't explain it either.  That doesn't happen fast enough either.  It takes some seconds of movement for RR to kick in.  It's usually not caused by a rate change, rather a transient  change in BP.

It is troubling but I was told not to worry.  Then it's just annoying.  Fortunately, mine is pretty well gone.

You know you're wired when...

Airport security welcomes you.

Member Quotes

It's much better to live with a pacemaker than to risk your life without one.