Pacemaker and running

Hello. I had a pacemaker for 3 years, the diagnosis was AV block grade 3 with a very low heart rate. With the pacemaker, I have largely been able to resume my running hobby. When I run, it sometimes happens after a certain time with a given intensity that the pacemaker changes mode or works in a different way. The consequence is that the symptom from before the pacemaker installation and with AV block 3 diagnosis returns. Others who have experienced this? Can there be a pacemaker setting?


yes it's a setting!

by Tracey_E - 2022-05-04 09:31:32

With av block, our sinus rate is more or less normal but the signal isn't making it to the ventricles. The pacer watches, every time the atria beats but the ventricles don't follow, it kicks in with pacing in the ventricles.

The pacer will only do this up to it's programmed upper limit. If your heart rate is always the same when you are symptomatic- say 130 or 140- then you are hitting that upper limit and it needs to be raised so that the heart can continue to stay in sync. Ideally you want your upper limit to be 10-15 bpm above however high your sinus rate gets. Mine gets to 165-170, so my upper limit is 190.

If your rate is dropping when you are symptomatic, that's something else with an easy fix. Some pacers have a feature that watches for afib, and if the sinus rate gets too fast it puts us in an artificial 2:1 block so it's only pacing the ventricles once for every 2 atrial beats. Great idea if you are in afib, but if your rate is up because you are running it feels similar to running into a wall! If you have no history of afib, this can be turned off. 

There are a few other things it could be, but those are the two most common. If either is happening, they should be able to see it in the interrogation reports and reprogram to work around it. Another way to fine tune it is put us on a treadmill. 

This is perfectly normal! They send us home with a good guess, but we are all different and have individual needs so it's not uncommon to take a few tries to get it right. If we are active, we are going to be a little harder to fine tune. Don't be shy about going back if you don't feel right. If adjusting a couple of times still doesn't get it, ask for the treadmill. 

HB diagnosis

by Persephone - 2022-05-04 11:08:02

It sounds like you're overall feeling well, Dagmunn - that's good to hear. In my case, though I also had the HB diagnosis, turning rate response on worked for me although it would typically be reserved for those diagnosed with sinus rhythm issues. So it was just a bit more complicated than it seemed on the surface, I suppose. A treadmill test with the PM tech present to make adjustments did it for me. I wouldn't hesitate to go back and ask for more adjustments if that particular visit hadn't addressed all of my concerns. Hope it goes great for you :)


by - 2022-05-05 01:29:19

Thanks for the helpful answers. My Pm is programmed in DDD mode 45 -175. The heart rate does not decrease particularly when the situation occurs, but is usually in the range 158 - 168. It is a bit strange that it occurred in exactly the same place during this year's Bergen City 1/2 Marathon (Norway) as in 2021, exactly on the same street . I contact my PM hospital.



by Tracey_E - 2022-05-05 10:00:21

They can look at the interrogation report and see what is happening when your rate gets up there. It's possible you're hitting your upper limit, 168 is close enough to 175 that could be it. 

When I got on the treadmill, we saw that I was hitting my upper limit (most of my problem) but also sometimes my sinus rate will tank for a second or two, then pick up again. They were able to program it so if it drops too quickly, it will pace atrial to keep my rate up. The treadmill is a great diagnostic tool. 

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