CRT-P Settings for Cycling

Does anyone have any information on the range of settings on a Medtronic CRT-P.?

I am now 75, I have always tried to keep fit but in 2007 I had a triple by-pass and then in 2018 I went into full AF-b. Since then, I have had 2 Cardioversions and they both only lasted days. I have been treated with Amiodarone for the last 18 months and it did stop the AF-b. However, in mid-March I started with Atrial Flutter and my heart rate has been 85/95 bpm at rest, before it was normally 45/50bpm. Also, as soon as I start moving around it goes up to 120 + bpm and I am very short of breath. I have been checked out and the conclusion is that the medication that I am on is now not working.

In mid-April I was fitted with a Medtronic CRT-P and the three wires. After 4 weeks the information was downloaded from the device and I have now been told that I will have to undergo an AV Node ablation.

I am a keen road cyclist and I have been told that it should allow me to restart and continue to cycling.

I have seen on the internet, a number of comments about problems with getting the units set correctly to allow road cycling.

Has anyone got any tips for me, to ensuring that I provide, sufficient and relative information, to allow the Technician/Doctor to suitably setup the device first time?   



by AgentX86 - 2022-06-03 12:57:50

I'm very much like you.  I had a triple (should have been four but ran out of heart/lung macine time) bypass, an LAA clip, and Cox maze, at 62 (69 now). The maze got rid of my long-time persistent Afib but traded it for permanent atypical flutter (not a good trade). I had three failed ablations and tried every drug in the book, short of Tikosyn.  That was the next step but Sotalol damaged my SI node so a pacemaker was needed.  I had an AV ablation at the same time.

My flutter symptoms were about the same as yours (unusual). My cardiologist was amazed that I knew (exactly) when I went into AFL. Cardiologists missed it completely.  I had an ER cardiologist argue with me, saying that I wasn't in flutter (OK, whatever).  My EP pulled it right out of the same EKG and showed me how to see it. He covered for ER guy saying that it's not easy to see.  Hell, I could see it.  A trained cardiologist?  BTW, I knew exactly when I went into flutter by looking at my FitBit record.  The sudden jump from ~50bpm to ~90bpm.

There are no typical pacemaker settings.  They're 100% based on the reason you have a pacemaker, your body's reaction to being paced, and your type and level of activity.  It's really guess, try, rinse, repeat.  A treadmill test can help but it's not likely to be the end-all.  After four years, I'm still having my settings tweaked.

Ameoderone is a very dangerous drug.  It plays hell with all of your organs.  As it was explained to me, it's not a matter if it will cause organ damage, but which one and when. My cardiologist and EP would only keep me on it for six months at a time.  I did that three times over five years.  Even then it damaged my thyroid.  Fortunately, it recovered after I stopped taking it.

An AV node ablation isn't a "have to" it's a matter of symptoms.  If you can stand the AF/AFL, you don't need it.  If it greatly affects your quality of life, as in you can't function with it, maybe.  You really have to try everything else first. It's the biggest hammer in the toolbox and is a one-way street. It will leave you dependent on your pacemaker, perhaps for your very life. Again, it's a QoL issue.  If you can avoid it, by all means do.  I couldn't.

Unfortunately, you likely have the wrong pacemaker for cycling. Pacemakers can't control rate the same way your heart does so they have to guess. Medtronic pacers have only an accelerometer for heart rate control.  The more your pacemaker moves, the faster your heart beats.  The idea is that motion = oxygen demand.  Two problems, driving on a bumpy road can fool it into thinking it needs to beat faster.  The second, more important to you, cycling doesn't involve much motion of the torso so the PM doesn't think you're doing much work.  Some have gotten this to work but it takes some real tuning.

First time? It's not going to happen. You can try with a stationary bike test.  This can be really hard to get doctors and insurance companies to go for it. It's not cheap. You'll likely have to go to the pacemaker clinic many times over several months before you're happy.

Avid Bicycle Rider

by Stache - 2022-06-08 00:25:06

I am 68 and an avid bicycle rider before and after my dual-chamber pacemaker install that beats 100% of the time.  My PM will increase my heart rate as I ride and so far the highest I have gotten it is 80 bpm on the bike.  Normally it beat 60 bpm.  My doctor told me I can ride as much as I want or can stand.

I lost my confidence riding and only took short rides to start now I am back up to four-hour rides with no issues.  My blood pressure has come down and my oxygen level is 98 to 100% all the time now.  I was off the bike for 2.5 months after 3rd-degree heart block.  I have regained my strength and confidence thanks to my two bikes.

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