Running with dual lead PM

I just got implanted with a dual lead PM from Medtronic (Azure XT DR). The reason for the PM is that I have a heart block and my AV node was not working.

The doctors told me that once I get this dual lead PM, I will be naturally paced by the SA node (our natural pacemaker)...meaning once the SA node fires, the PM detects that event and performs the function of the AV node by sending sending the signal to my heart's ventricles.

My question - is there a possibility that the PM will need further adjustment for optimal output from the heart?




by crustyg - 2021-07-22 03:17:37

Depending on lead placement and the sophistication of the software in your PM, it may need more or less tweaking to cope with variable AV node delay.

The challenge is that even though your SA-node does the pacing and your PM 'merely' detects that and fires off a matching impulse to your RV, the normal healthy heart also adjusts the delay at the AV-node as you demand more from the heart, and not all PMs will cope with the wide variation normally seen here without some adjustment.

Also, there is a maximum tracking rate that your PM will be set for (tracking==sense and then pace) which is often too low to start with.  I can't see your age, but very few EP-docs start a new athletic PM patient with a high-enough maxHR.  Until this is tweaked in your PM to match what your SA-node can deliver (perhaps 155-175BPM), your dual-chamber PM won't deliver what you need when working hard.

You can save a lot of time by asking your EP-doc to arrange a treadmill session where they tune your PM for your running.

Further adjustments

by Theknotguy - 2021-07-22 17:21:16

I agree with Crustyg.  The only thing I would add is that sometimes the Cardiologist/EP is reluctant to make quick changes so you may have to go back and forth several times until the unit is tweaked to its optimum.  There still may be some things that aren't as perfect as they were before you got the pacemaker but, at least, you'll know it can be changed.  After things were tweaked I was OK but then had to lift and move some heavy weights.  Found out my pacemaker wasn't adjusted for that so I had to move the heavy weights short distances at a time.  I'd just flat out ran out of air and there isn't necessarily a setting for that.

One other thing.  I was five years out and got a change in life style due to changes in my "job".  I had to walk down a 954 foot long hall and would always run out of air at/about the 900 foot mark.  Talked with my EP.  They did a few tests and determined it was my rate response.  Saw my regular tech for adjustments but they saw something on the tests and brought in the mfg. rep for my pacemaker.  He brought up some screens I had never seen before, asked me the date and time of my problem, then made some adjustments not available to the regular techs.  Point being there are more adjustments that can be made than what is available to the regular techs.  Fortunately my EP made that request before I even got into the discussion.  Not all EP's are as forward thinking.  The other point is that you can have changes further on down the line you don't or can't anticipate now and adjustments can be made at that time.

Overall I lead a full life with my pacemaker and am happy with what it has done.  

I hope your adjustment to your pacemaker goes well.

My experience so far

by quikjraw - 2021-07-26 06:21:51

Hi Snortingdonkey,

the link below is where I am at and it might be useful for you.

I am still not able to try the exercise settings they have changed me to but as soon as I am I will post my findings.

I was very into running before my implant and I am going to try my hardest to get back into it.

Exercise such as running and cycling are as much a part of me as my personality so it is very important to my wellbeing.

All the best 



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