heart rate increase

So I've Heard...

by Marybird - 2021-11-20 12:04:19

My daughter, whose first pacemaker was implanted in January 2012 when she was 27, told us she could increase her heart rate when she was exercising and it wouldn't go up enough ( walking, ballet) by tapping on the pacemaker- gently, I would hope, I couldn't see pounding on it.

Just on GP's, though, I can't say doing this is something I would recommend, and I would never do it. 

Tapping pacemakers

by AgentX86 - 2021-11-20 21:49:49

This is a common strategy for those of us with rate-response turned on.  Medtronic uses an accelerometer to infer how fast the heart has to beat to supply the oxygen to the body during exercise.  It's not a perfect strategy because all it can really do is measure footfalls.  The frequency of footfalls is the same if you're climbing stairs as it is walking down a hall.  Climbing stairs takes a lot more energy but the PM doesn't see it that way. Tapping on the PM fools it into thinking your're running (or some such), so it needs to beat faster.

This relates to another issue. If you drive down a bumpy road, your pacemaker may think you're walking or running causing the HR to increase, when you're just sitting there. This is why the PM's RR has to be balanced for each individual.  I'd rather have a fast response to give me mo oxygen when climbing stairs.  Others might not like the sensation of a raised HR when sitting in a car.  It's a tradeoff but talpping the PM is a stategy that some use to compensate for a slower than needed rate response.

The bottom line is that it's not going to hurt anything, though some may think you need a checkup from the neck up when you walk around beating on your chest.  ;-0

Upping The Pacemaker Heart Rate

by Marybird - 2021-11-21 11:21:41

Thanks for the explanations, Agent. I'd just wondered about the effectiveness of tapping the pacemaker to increase the heart rate when you're exercising and it's not increasing enough for a good workout, say when you're riding a bicycle, climbing stairs or other activities where you don't use your upper body so much. I'd be interested in hearing if others do this and does it give them satisfactory results? 

My daughter has done this when she wanted a "boost" in her heart rate, at least she used to, when she walked, and when she would practice ballet moves. I wouldn't do it as I seem to have come to regard my pacemaker like my belly button, don't care to touch either one. 

I think the rate response on my pacemaker is set adequately for my activities, and what will get it going ( and my heart rate into the low 100's or so) is rocking in one of our patio chairs. Going over a bumpy road will do it too but as you say, it's a tradeoff. I've also noted that changing positions in bed at night also bring up my heart rate- sometimes more than it needs to be, and more than it used to. But these days I seem to be battling off and on afib, and I take a bunch of medication to keep my heart rate down. I find that trying to exercise hard enough to get the heart rate up over 100 will trigger palpitations, probably afib, and find the only time my heart rate goes up over 100 it's due to ( probably) afib, or possibly the higher heart rate triggers the afib(?)  so I guess I can't encourage a higher rate than it'll go burdened as it is with the heart rate meds and the afib apparently taking any chance it can to rear its ugly head.

Increase heart rate by applying pressure to pacemaker site?

by Gemita - 2021-11-21 14:44:19

Judy, I certainly cannot increase my heart rate by applying pressure to my pacemaker site.  I have a Medtronic dual lead pacemaker too.    Perhaps I do not have Rate Response turned on.  Seems to me this practice would not be a long term solution for any problem you might be having, or is this just an observation?  At best applying pressure to our pacemaker or tapping it to increase heart rate can only be a temporary measure and not a very practical one during movement I wouldn’t imagine.  If I had to resort to this behaviour, I would ask myself, why do I have a pacemaker?  I would rather work with my EP or technician to try to achieve a permanent fix for any difficulty I might be having. 

Marybird/AgentX86:  After reading your posts, I feel my Rate Response is probably off.  Do you suffer from chronotropic incompetence (CI) Mary because of high dose beta blockers?  Although I had evidence of CI prior to my pacemaker, I don’t believe I have too much of a problem any more.  My pacemaker ID card though shows mode of pacing as AAI-R, so a question for my EP.  I wonder whether turning Rate Response off would help control your sudden tachy events Mary?  You do seem to be over sensitive to movement and that cannot be a good thing with your tachycardia.  I can go over bumpy roads, rock in the rocking chair all day (if only) and still my heart stays quiet(!)

Rate Response

by Marybird - 2021-11-21 16:40:18

Gemita, I think CI was one of my big problems before the pacemaker, and when the EP had the rate response turned on at my 5 week post-implant visit it made the biggest difference, I felt so much better. The CI may be in part due to the rate control medications I take to control the heart rate, though without those medications ( especially the metoprolol) I'd be spending most of my time in tachycardia- with heart rates bumping up into the 200's or so (it's happened before). Before the pacemaker, unless I was having tachycardia, my heart rate would spend much of its time in the 40's , and moderate to even more than moderate exercise would bring the heart rate into the low 50's much of the time- and I can tell you it's hard to wash windows, trim hedges and drag tree limbs and cuttings to the edge of the road with a heart rate in the low 50's, and going back into the 40's when you stop for a moment. We noticed the same thing happened as I tapered down the metoprolol to switch to diltiazem- and also did the same thing when I was on a low dose of diltiazem, so the EPs and my cardiologist all agreed that the SSS was me, perhaps brought out or enhanced by the medication, but not due solely to the medication.

Now, however, with the rate response turned on, my heart rate ( even with the medications) goes into the 70's and 80's with normal activity, and I don't have the exhaustion and light-headedness I had before the pacemaker. I feel so much better, have lots more energy, and I can thank the pacemaker, including its rate response function, for that. Before I had the rate response turned on ( the first five weeks of the pacemaker, my atrial pacing rate was at 84%, at my last in office check it was at 94%, and I feel much better, so I think that speaks to the pacemaker rate response function being a good thing for me.)

I'm not sure at all that my apparent sensitivity to movement, causing an untoward increase in the heart rate at times ( it doesn't happen all the time) is due to the rate response settings, they haven't changed since the EP had them set at my 5 week checkup. Most of the time I'd say the increase is appropriate for my activity, and I'd think the occasional increase due to the bumpy roads ( we don't have many around here, fortunately) and when I rock in that chair on the patio ( not often, it makes me nauseated in addition to increasing the heart rate) might just be due to the rate response but is a tradeoff for functioning well during normal activity.

I'd also noted an increase in heart rate when I flipped over to my right side in bed at night, not necessarily other movements, but these only lasted a minute or so and the rate wasn't that high. I am seeing an increase in heart rates more often, and higher rates ( when I check them), during those movements, but I think they might be due to short runs of afib which seem to come on just about any time they feel like it, sometimes during exercise, but even during normal activity. They don't last long, and don't feel terrible, so I tend to dismiss them. I figure with the remote monitor my cardiologist and company will get the reports and they can determine if anything needs to be done about them, and will let me know about how often, how long, or what might actually be occurring.

CI, Rate response, and Metoprolol

by AgentX86 - 2021-11-21 23:22:31

With CI, metoprolol won't affect the heart rate.  It's completely under control of the pacemaker. It still slows the nervous system and will help control ectopics and lower BP.

I agree that thumping the chest isn't the best fix but all of these settings are a tradeoff and it may be impossible to balance the settings for everyone without some compromise somewhere.  It seems that some don't know to try or aren't getting any support from their ep/device clinic. Tapping on the chest certainly isn't in the "on label" use of the PM but it often works.

As I said, I had my RR sensitivity cranked up, with the warning from the device tech that I may not like the results. It was odd driving home and my heart rate felt jumpy for a short time but it didn't take long for it to just be another bellybutton. My RR still doesn't cover all situations. Stairs, hills, and strenuous activity don't give any information to RR, so the I suck wind after. Some might think I'm out of shape but it's just that RR can't respond. Tapping might help but as noted it's not always practical.