Heart rate

Just wondering what most people have their heart rate set at after getting the pacemaker and why they start out at 80 and eventually go to 60.


Resting Heart Rate

by IAN MC - 2021-07-21 14:38:19

Hi Dickie    You may be making a false assumption that " most people start out at 80 and eventually go to 60 ".

Anything between 60 and 100 bpm is considered to be a normal resting HR and Drs often attempt to match the PM lower limit to the resting HR which you are accustomed to.

For what it is worth, I started with a PM lower limit of 50 bpm and asked for it to be increased to 55 bpm...... this was vastly better for me but we are all different.

Another factor is .. the higher the setting, the more the battery is used up. This may influence some doctors !

The only thing that matters is HOW YOU FEEL !

Best of luck



Combination of default settings and your heart muscle health + age

by crustyg - 2021-07-21 14:43:12

Many EP-docs leave a PM set to factory default from first implantation, with perhaps a little tweaking, but I think there's more variation than perhaps you are aware of.  I think 60-130BPM is quite common, but plenty of older patients who've been struggling at 60BPM are more likely to have a higher lowest rate.

I started at 50-130 (previous resting HR of about 42BPM which was fine for walking around, but not great for a domestic flight of stairs (SSS+CI)).

At the risk of being simplistic, patients get a PM for a variety of reasons and and many EP-docs will adjust initial settings to reflect that.  There are contributors here who have started at 70BPM and later had the lower rate adjusted up.  Quite a few (where the PM supports this) then have a lower rate for sleep.


Pardon me, Ian....

by crustyg - 2021-07-21 14:50:48

But please don't feed the myth that *any* EP-doc will select a lower pacing rate with a view to conserving battery life.  They DO NOT.

Pacing rate (pacing pulses per day) is surprisingly constant for people and really is NOT a major factor in battery life: my PM paces me all of the time, but my paced outputs per day is very similar to an 80year old with lower rate of 80BPM..  Pacing voltage and pacing width are MUCH bigger factors for battery life - in other words the quality of lead=>heart muscle is a major determinant, as is single- or dual-chamber pacing.

I fully accept that towards the end of PM battery life, it *may* be appropriate to avoid increasing the battery load by tweaking BPM settings upwards, but that's different.

Pardon me, Crusty

by IAN MC - 2021-07-21 15:00:37

...... but this is an international forum representing a whole variety of health systems with a multitude of economic restraints.

I would be astonished if this is not reflected in the choice of the heart base-rate in some parts of the world !



Heart rate setting following pacemaker implant

by Gemita - 2021-07-21 15:38:18

Hello Dickie,

You ask specifically why some of us start out at 80 bpm and eventually go to 60 bpm? This is not always the case of course, for example I started out at 70 bpm and have stayed at 70 bpm for 3+ years now because the higher setting suits me.  

I think it largely depends on your heart condition and the reason for your pacemaker.  My doctors felt that a higher heart rate for Sick Sinus Syndrome would suit me better than a basic rate of 60 bpm and it has proved to be so.  

There are specific instances however where it would be safer to start a patient out on a higher heart rate.  For example, after an AV Node ablation for atrial fibrillation, they usually like to increase the lower pacing rate immediately after the ablation to help decrease the potential risk of sudden cardiac death in some patients because some serious complications, such as ventricular arrhythmias and sudden death, have occurred post-operatively.  It has been suggested that a higher pacing rate immediately following AV Node ablation (say a setting of 80-90 bpm) may decrease the occurrence of sudden death and then your doctors would gradually reduce this rate over three months.  But of course this is only one specific reason, so perhaps you should ask your doctors why in your case your setting has been set to 80 bpm initially, if that is indeed the case?

60 to 55

by MartyP - 2021-07-21 17:13:00

I started at 60, but that was too high for me, it felt like my heart was always beating to hard.

Lowered to 55 and it's been that way since 2017 ....

Heart Rate Limits on Pacemaker

by Marybird - 2021-07-21 17:31:00

During my 6 week post implant checkup, my EP set my lower limit of pacing at 55, and along with some other adjustments, turned on the rate response. He explained to me that this would allow a lower pacing rate when I was sleeping, as a heart rate of 60 isn't needed for sleeping. He explained that I wouldn't see a heart rate of 55 that  often, because with the rate response any activity on my part would bump up the heart rate where it needed to be. I've found that to be the case, my heart rate now goes into the 70's or 80's or so with moderate activity, before the pacemaker it was lucky to get into the low 50's with the same activity, and would fall to the  low 40's when I paused. Unless I had an episode of tachycardia- but a heart rate of 160 under those circumstances isn't all that energy- generating, either. Seems my heart rate hangs around 60-62 at rest ( hung in the low 40's much of the time before the pacer) and they tell me my atrial pacing rate these days is around 92-95%. 

The EP also reset the upper pacing limit from 130 to 120, and the tachycardia alert threshold from 180 down to 140, as he said my monitoring records showed tachy often at 140. The upper limit of 120 was set so as not to overlap or interfere with the tachy alert at 140. 

That upper limit of 120 is fine for me, seems with a diagnosis of a-fib they don't want my heart rate going over 110. I exercise the best I can, they tell me to go for the amount of time exercised rather than trying to achieve a target heart rate.

My resting rate was raised

by Elisabet - 2021-07-23 17:47:35

My normal rate was rarely below 90 for over twenty years before I got the pacemaker; apparently many of us long-term survivors who had radiation therapy have these little bird hearts. 

I felt much better when my rate was adjusted up from the default, which I think was 60. It was still much lower than I was used to, but better than the bouts of 40 I was having during episodes of heart block!

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