First year Check up

Hi All, 

It has been just over a year since my dual chamber Medtronic PM was implanted for AV block 2:1.

I have some ups & downs (some off which I have queried on the forum, big thanks to Frank P for sharing his settings information)

Next week I have my first yearly check up for the device, it will take place at the hospital where it was implanted.

I am a young (ish) 39 and very much into the outdoors, activities such as cycle touring, trekking & climbing. I need to be able to continue in these pursuits (for my sanity) and therefore need help asking the medical team some pin point questions ensuring my continued participation

I am aware that Medtronic PMs are maybe not that best suited devices on the market for active recipients however I will be with mine for the next 9 years (battery life cycle) so need help getting it finally tuned for my specific needs:

Would anyone be kind enough, to help me with some questions? 

My questions so far hinge around the below:

Rate Response settings (optimised for sports?) 

Rate Profile Optimisation (what are the most efficient for an active person and are they set to those parameters?

Is my RR Optimsation turned on or off?

Adjusting my ADL rate & setpoint ( where is it currently set? And where should it be set to facilitate best physical activity outcomes?)

Adjusting my UR setpoint to best suit an active lifestyle, where should this be set? 

Lastly are there any other specific technical questions I should be asking that will make ensure my PM is finely tuned for physical demanding tasks?

Any help would be very much appreciated 





1 Year

by AgentX86 - 2021-08-10 20:05:39

I think you're making this process out to be much simpler than t is. There is "no one size fits all" or there wouldn't be so many settings. You have to your settings tuned for you. The P< tech can't just listen to your wishes (for the best tuning). To get there can be a long process of trial and error. A stress test (treadmill or stationary bike) may get you there suuner but it's not something you can just tell the tech to do. You might not even like the side effects of some of the more aggressive settings.

You being too aggressve may just piss them off, too.  You really want the technicians (and doctors, nurses,...) on your side. Go easy.

You should be able to get your current settings at any time. Make sure you get them before you leave.


by HeartyOne - 2021-08-11 05:15:48

Thanks for the reply AgentX86, I would add that I have a nomadic life, and don't stay in one place for very long, that is why      this appointment is important for me to get right.

I don't want to assume that this is in any way a simple fix,                I am basing most of my information from advice that was given on this forum in regards to trying to achieve optimumal setting for PMs for people with a desire to have an active lifestyle. With the caveat that it is patient specific, so maybe not be suitable for me.

I appreciate that this will be a trail & error situation, however I obviously want to have some questions to ask and get responses to which is fair enough without being pushy in any way.

I believe this is the best path forward to helping me achieve the desired outcome for my health.

Thanks again & all the best 


by AgentX86 - 2021-08-11 12:17:17

It is your best path forward but understand that they're the "experts". Mo one likes to be told how to do their job. OTOH, almost everyone likes to talk about their job. Asking questions in a leading way is often a good strategy. Of course any and all questions deserve an answer.

I believe your best bet is to have a tuneup on a treadmill or exercise bike, whichever more closely matches your lifestyle. This may be difficult but it is something to insist upon.

You still may not like those settings for everyday living. Often aggresseve settings can cause unpleasant side effects like a racing heartbeat when driving over bumpy roads. I found it to be a really odd sensation but learned to live with it because it worked better when I needed a boost (stairs or moving heavy objects are still, and always will be problematic). This is why they pretty much insist on incremental changes.

Good luck with your check up.  Let us know how it goes.

Great Experience

by HeartyOne - 2021-08-19 07:56:59

Hi all,

Just had my check up, managed to see the Professor of Cardiology at the hospital that did my implant. 
Had a sit down chat about my situation & experience with my PM over the first year.
We talked about how Medtronic PM we're not the best suited to certain sports certainly cycling, in his words "they shit for that".

He advised my that if I was not entirely happy with the Medtronic pm I could switch it out for a Biotronic "closed looped" pm that in his opinion are the best for sporty folks.

We discussed the pros & cons of RR setting, ADL set points etc,. Including how changing these settings could improve my preformance in cycling but have a negative impact on walking in the day to day.

I talked about my desire for twicking the pms setting to ensure the best setting for sports.
We did a ECG followed by a look at the PMs settings, where he noticed my upper tracking limit was set quite low, he informed my this was not ideal, he then proceeded to increase the upper limit, which should see me get better results during exercise.

All in all a great experience, so happy to have a medical professional at his level give me the time to go through my issues. 

Just need to get on the bike and start peddling now 🙏

All the best..

Positive Progression

by HeartyOne - 2021-08-30 06:43:50

Hi All, 

Just an update after a few weeks since my check up, as I always seem to need a week or two for things to settle in when changes to my PM have been made.

So, the hospital sent me a letter detailing the check up and confirmed changes and some key recordings from the PM.

My ADL rate was increased to 95/min & my upper tracking rate was increased  to 155/min. With a note stating I had 5 episodes of oversensing during exercise.

I am really pleased to say that they changes have made a world of difference, I don't get that sluggish winded feeling anymore when quickly running up strairs & things on my first 40 Km bike ride last week went great, pushed the whole way and didn't have that sensation of being held back or not being able to push my physical abilities.

Shout out to everyone on the forum who gave me some insight into getting my setting optimised for my PM, and to a doctor who listened.

To any one who is just at the start of their PM journey or someone struggling with the journey, keep your heads up & stay positive.

Never thought I would feel this good again..

All the best 




Active PM Setting

by Stache - 2021-09-13 18:41:37

I am a very active older guy that has been full throttle his whole life I am now 67 and a very active mountain bike rider and hiker.  The heavy load backpack is out as it rubs my PM and wires on my dual-chamber 100% pacing.  Can't take a chance of breaking my wires with the backpack.

My PM is set at 60 bpm (St, Jude by Abbot PM)  it will increase my heart rate up to 140 bpm but the most I have seen is 80 bpm during stressful bike rides.  I have only had it for 6-months with just one minor adjustment about a month ago to increase sensitive input for my bedside transmitter.

The doctor told me to push the bicycle riding and my body will tell me if I do too much.  I have had a great concern as I ride really hard all the time but so far it has not affected or hurt me.  I recover very quickly after my rides of 30 to 40-mile.  I am working back up to 100-miles rides but not there yet just halfway.

I was told my higher heart rate will drain my battery faster but not to worry they will make more PMs.  Like you I am still learning my limits.

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