Recovery HR not going down fast enough

Hello everyone...

I just got a dual lead Medtronic Azure XT DR MRI SureScan implanted (they removed the older single lead PM so that I can have synchronicity between upper and lower chambers.) I have a working SA node but am suffering from a complete heart block because my AV node isn't working right. My PM has been configured so that the SA node drives the AV node. 

I went for a 2 mile run for the first time yesterday. The run felt normal but I realized after the run ended when I was cooling down that my HR was not coming down fast enough as it usually does. For example, at the end of the run my HR was 144...and it took about 2 hours for it come down to 90s.

I am an endurance athlete and while I might be a little out of shape, I can emphatically state that there is no way that the SA node is recovering that slowly. This has never happened before even when I had the single lead PM...my HR always came down rapidly within 3 min. It feels like there might be some setting on the PM that is inhibiting the rate to come down...now the confusing thing here is that I realize that the SA node is driving the AV node and so the obvious question is how can this happen (I don't know the answer). I do know that the Apple Watch (which is what I am using to capture the HR) captures the ventricular HR (and not the atrial HR). I don't really know if there is situation here the atrial node is beating at a lower rate and due to some setting the ventricular node is left on its own to recover based on some setting? 

ADDED PM SETTINGS BELOW:

ADL Rate = 125 bpm

ADL Response = 4

ADL Setpoint = 5

Exertion Response = 4

UR Setpoint = 76

Activity Acceleration = 15 sec

Rate Adaptive AV = On

Rate Adaptive AV Start Rate = 90 bpm

Rate Adaptive AV Stop Rate = 175 bpm

Min Paced AV = 110 ms

Min Sensed AV = 80 ms

 

Thoughts? 

 


8 Comments

Settings?

by ar_vin - 2021-08-19 12:47:28

Have your EP/device techs check your settings. Get your settings data from your last PM interrogation and read the PM manuals and numerous posts on this site to see what might need to be tweaked.

Maybe even post your settings here so others might look them over and give you some tips.

 

Should be an easy fix !

by IAN MC - 2021-08-19 13:06:04

As ar_vin says this problem is related to settings.

It sounds as though you have Rate Response switched on and the " Activity Deceleration "  setting needs tweaking.

This setting determines how quickly the pacing rate declines to the target sensor rate when your activity / exercise stops.

I am a runner and had a similar problem with my Medtronic PM.

There is also an Activity Acceleration setting which determines how quickly your HR increases

Let us know how you get on

Ian

Settings added

by SNORTINGDONKEY - 2021-08-19 14:16:42

Thank you for the comments...I just added settings to the original post.

SNORTINGDONKEY

by IAN MC - 2021-08-19 14:36:15

The settings which you have added confirm that you do have Rate Response switched on so you do need your PM to help your heart-rate respond to exercise.

However the cause of your problems is the Activity DECELERATION  setting which you have not listed. As I said in my previous post, it is an easy fix !

Ian

Activity DECELERATION

by ar_vin - 2021-08-19 14:53:42

Exactly!

Over time you've posted multiple times about related issues - please go back and look at those posts - the responses you got point all this out.

Please also spend some time reading the settings info in the Medtronic PM manuals.

 

Ok

by SNORTINGDONKEY - 2021-08-19 15:03:32

@ar_vin - all my previous posts were when I was in a different situation with a single lead PM. I just got new PM about a month ago and have begun to run very recently. I am now facing some issues that I have never faced before. Regarding, your comment about the manuals, yes, I do read them but sometimes it's not clear to me. Therefore, I rely on forums like this to provide a ready index to the solution. It seems to me that is one purpose of such discussion boards.

Regarding the activity decelaration setting, it looks like they did not modify it and so the printout does not have it. I will ask the techs.

OK

by ar_vin - 2021-08-19 15:23:48

Most Medtronic PMs have similar settings regardless of single or dual lead.

Please do yourself a favor and read your old posts AND the responses you got - it' ALL in there.

Also look at the settings doc you got from Frank. Make sure to read the Medtronic manual for your PM.

Apple watch as HR monitor and ECG

by Ahilltopper - 2021-08-22 17:39:50

The Apple Watch 6 (and 3, 4, 5) does not distinguish between atrial and ventricular heart rate in normal use.  It is uses an optical sensor (PPG) on your wrist, which measures HR by using the pulse (blood flow) rate.  Only when you use the ECG app, when you are still (will not work while moving), and have a finger touching the metal crown, it can measure an electrical signal across your chest that is equivalent to a single lead ECG - to detect arrythmias.  I've never seen one of my cardiologists rely on a single lead ECG, ever.  the Apple Watch ECG function was designed to detect Afib, but it won't work when you really need it - exercising vigorously.   Having said that I love my Apple Watch 6 as a HR monitor.  

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