This has been discussef previously but I remain unclear. I had a Biotronik two lead implanted 11/20 for SSS, Brady/Tachy. I saw my cardiologist this week and he is managing the PM because he had pretty much given an ultimatum to either go to him or the EP, but not both.

My settings are 60/120. I routinely go to about 128 when I do my daily walks. Using the equation to determine HR for cardio fitness, my rate would be 116.

I thought that your upper setting should be slightly above what you were likely to do. He says anything above 120 is my heart, not the PM and there's no need to raise the upper limit. 

I have to say I was somewhat stunned when he looked at my EKG and said he was going to use it in a book he's writing. He didn't even ask if that was okay. I think he sees it as a typical EKG of someone with a pacemaker. I gather he believes he owns test results.  

I admit I haven't liked the control others have over my body since implantation. I hate when the device nurse taunted she was going to raise my heart rate until I feel uncomfortable. You know, " we go, wheeee.."

Does keeping the setting as is seem right?


Dealing with the clinics

by Persephone - 2021-06-04 14:29:11

Hi Pharnowa - I don't have upper limit setting comments to contribute to your question, but just wanted to let you know that I'm fully with you on your "here we go, wheee" comment!  The turning down all the way is bad, too :(.  With the covid shut downs I haven't been to the clinic in quite a while, so will have to steel myself when the time comes to go back.  At least my doc is very kind and patient (even if he doesn't seem to have any idea how to correctly take a blood pressure reading).

Upper limit (Tracking Rate)

by Gemita - 2021-06-04 14:48:46

Pharnowa, did you ever get a treatmill test to help optimise your settings as we suggested in your earlier post?  I honestly believe this is what is needed.  I also feel, if I may say, that you have outgrown your cardiologist and you might be better off changing your mind and working with an EP in the future.  I think your cardiologist expected this to happen in any event and I don't really feel that the relationship between you is ideal any more but perhaps I am reading more into this than I should.

Does keeping the setting as it is seem right?  No it doesn't.  120 is the bare minimum and probably factory setting.  Even mine is set at 130 and I am struggling at times during exercise.  As I mentioned previously, my pacemaker can tell the difference between a high heart rate caused by an arrhythmia and one caused by exercise but I still have difficulties when I approach my upper limit of 130.  I will be asking if my upper limit can be safely raised too when I go back for review in July.  If not, I hope to receive a proper explanation this time.  

By the way, how do you feel with an upper tracking limit of 120?  How does it affect you?  If you have symptoms when you reach your limit, this would be an indication that you need an adjustment to your settings.  

I do hope for the best for you and that you will find a doctor and nurse you can happily work with.  

Cardiologists and EPs

by AgentX86 - 2021-06-04 14:49:50

If you don't like the answers your doctors give or the treatment, find ones who you trust.  Telling you to go to him or an EP is just wrong.  If the only problem you have is electrical, I can see how only going to an EP might be reasonable but an EP is a very specialized specialist.  A cardiologist can take care of the more "mundane" heart issues, managing the day to day and general heart health matters (blood/cholesterol testing and such).  You may only see the EP once a year but it's a good idea to maintain a relationship with both.  If you need them, you're already a patient.

As far as maximum rate qoes, there is a lot that figures into it.  Much is how your doctor feels about the stress on your heart. If your heart will go on its own, there isn't much that can be done about it, even if there were a reason.  Using your EKG to write a book shouldn't be a problem.  Obviously you won't be linked to it in any way.  Yes, it really is his.  For one, you couldn't prove that it was yours in court. 

There really isn't much reason to worry about this stuff..  It's for your benefit.  Being a control freak isn't going to help.  I only ask that they tell me before the "wheee" moment.  Barfing in their office is probably frowned upon.



Thank you?

by Pharnowa - 2021-06-05 01:00:26

I inquired about the stress test, Gemita, but was told it wasn't necessary. I may be wrong, but I question the cardiologist really understanding PMs. I'm sure he knows the scientific basis, but not  the daily nut and bolts of adjusting. The only good thing is they use a company rep. I will not have an in person interrogation until January. They supposedly do monthly telephone ones, but I haven't been called.

I routinely go to 128 while walking. I don't know when I exceed my upper limit of 120, so I don't think I feel much except I purposely push. I can't say I feel great pushing up the hills, but I don't  think it's a harmful thing.

I don't have any other cardiac problems and my cholesterol medication is handled by my endocrinologist. My BP and  cholesterol are excellent. I do get Eliqis from the cardiologist, but the EP offered to give it.

I think I made a mistake in staying with this group. I don't see anything at all wrong with wanting an EP to optimize my functioning. The EP was fine with my seeing him twice yearly and seeing the cardiogist too. 

Agent86, ad for the book, I don't care. I felt he was pointing out he's writing a book and that he's putting my EKG in his book. It lacked simple courtesy.

I am going to figure out how I can reverse and return to my EP. 

Persephone, I didn't even know about turning down at interrogation. Oh boy...........  :)

Thank you all!





Your doc is correct.

by PacedNRunning - 2021-06-06 04:17:50

If your own heart is exceeding the upper limit it means your own heart is Doing the work. The max upper limit is how far the pacemaker will pace the heart. Over that it still watch's you but it will Not pace above your 120bpm. Are you feeling symptoms or are you only concerned because it's over your max and you don't know why? If you have Bradycardia, then you most likely do not need the pacemaker above your lower rate limit. :). Hope that helps. Not sure why your asking to have your upper limit raised. 

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