Athletic endurance after Pacemaker

I had a dual chamber pacemaker implanted in early June (3 1/2 months ago) for complete heart block with no other heart conditions. My device is a Medronics W1DR01 Azure XT DR. These are the setting according to the tech (50 - 140).

I'm 68 years old, before the implant would walk for an hour 3-4 day a week, and bike ride a few hours 2-3 or days. I gradually started back walking and biking after the implant. My endurance is not what it was before the implant. When I walk I notice that I have to stop sometimes when going up hills. My walking endurance seems to be about %70 of what it was before. My biking endurance seems to be about 50% or less.

Can I expect my endurance levels to return close to %100?


PM settings for rate response

by ar_vin - 2021-09-28 16:52:13

Your PM seetings need to be adjusted to support your activities.

Your Medtronic PM has an accelerometer that senses your upper body movement and can be set to adjust your HR to match your activity. This feature is known as "rate response".

Check out the following thread:

Search the forums for many previous threads about Medtronic rate response settings.

Read that thread and several recent threads to understand what you may need. Also download the manuals for your PM model from the Medtronic website, read and understand the settings. Once you understand what you need, make an appointment with your EP and have his clinic adjust your PM settings. It might take a couple of sessions before your settings are dialed in to your activities.


Rate Response

by AgentX86 - 2021-09-28 18:36:51

I was about to write suggesting that tuning was perhaps necessary but if heart block is the only issue ("no other heart conditions"), why would RR be turned on? If it is, perhaps it shouldn't be.

Excellent point Agent

by ar_vin - 2021-09-29 01:02:21

Sorry I didn't read the original post carefully enough - good catch.

But the symptoms seemed to point to potential chronotropic incompetence; perhaps not.


50-140 sounds like one of the issues

by quikjraw - 2021-09-29 08:30:16

Hi Biker97,

The first point would be that you will always see a drop off in performance after a pacemaker simply becuase of the disruption to your heart. 

You appear to have much more drop off than I would expect, especially for biking. Do you know what your heart rate used to be when you were biking? if it was often above 140 then if I am reading your post correctly your heart will no longer be beating above 140bpm as the pacemaker is set at a maximum of 140bpm.

As you have full heart block the pacemaker limits are now your limits.

I would investigate first if during cycling or walking if your heart rate is climbing towards 140. if it is you will start to struggle unless they increase your higher rate or your heart becomes stronger. 

hope that helps



upper limit

by Tracey_E - 2021-09-29 09:26:54

When you don't feel well is your rate exactly 140? If yes, then you need your upper limit adjusted. If your sinus rate is normal and getting to 150 or 160, the pacer can only make the ventricles go as fast as it's programmed to go, in your case 140. That's an easy fix. 

As Agent pointed out, rate response shouldn't be an issue if you have heart block. However, you might be like me. Most people with heart block have a normal sinus rhythm so all the pacer has to do is play follow the leader and make the ventricles beat in sync with the atria. I have some atrial issues also, but they were hidden by the heart block and we didn't discover them until after the block was fixed. I use my rate response, and it took some time to get it fine tuned for my needs working out. They start us with a good guess and go from there. It's normal to take a couple of tries to get it just right. 

It's also possible that rate response is turned on but you don't need it and it's competing with your natural sinus rhythm. If that's the case, you might feel better with it off.

All the pacer does is add beats so in theory you should be able to do all you did before, and then some once you heal. We get deconditioned more quickly than we think. Pacer surgery is a simple surgery, but it's still a surgery and it takes time for the body to heal and adjust. Perhaps the answer is just more time. 

Bottom line, go back and have the pacer checked. They can tell easily if you are bumping your upper limit, if rr is turned on unnecessarily, if you are pacing atrial. 

Yes. It will improve.

by PacedNRunning - 2021-10-02 04:44:35

With a pacemaker your heart doesn't beat at the same efficiency or way a unpaced heart does. I am a runner. I noticed after PM, my stamina wasn't as good. I went back to running 2 weeks post and man I wss Wiped 30mins into my run. After a few runs I went back to building my stamina. I ran less distance and time and slowly increased as my body and heart got use to pacing. Now I'm back to running longer. I can be tired still after running more than an hour but I expect that. My doctor recommended no more than 60 mins of Cardio at a time. So yes. Just start back af with 30 mins of walking vs 1 hour and slowly building up as you feel less tired. As far as others talking about making adjustments a lot of doctors don't like pacing the heart at high heart rates. So it really depends on your condition. 

upper limit

by dwelch - 2021-10-09 10:21:31

same here.   Upper limit.  I have complete heart block as well.  Very athletic before and after the first one.   a pacer easily fixes heart block so you have a normal working heart now.  although maybe paced higher.  Know your upper and lower limits (ask for a copy of the printout when you go in, it and other good stuff is on there (the batterry life estimate is not good, ignore it....seriously)).  It is difficult for us to take our pulse, you need to do it a full minute (dont cheat) if you are doing it against a clock, watches and other electronic devices are easily fooled.   The pulseox devices for like $15 at amazon are light based and should not in any way be affected by the pacer.  so it may be difficult to find out where you are when running, but maybe you are pushing your limit.

Or maybe it is settings and the device is not pacing properly, which may show when you go for your next visit, in that case you would be like you were before so I dont think that is it.  

Medtronic Adsisa DR 01

by thejoe056 - 2021-11-01 12:43:05

Wondering if any body has had experience with adjusting the settings on this model of PM? Just finished a CPET test and fatigued at a heart rate less than desirable? Been beating my brains out for over 40 years running and bike once very competitive! Now, just trying to suffer less at 77 while riding about 100 mile a week! We have those obnoxious hills! Fatigue not fun! I have normal sinus rythem now, after three ablations for Flutter! Never had FIB! Thanks, Joe 

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