What factor(s) determine where the pacemaker pulse rate is set ?

On my second pacemaker now for about 2 years. First one was set to keep me@ 60 PR, and second one was set also @ 60 PR. However, I developed AFib about a year ago and have more symptoms with feeling out of breath and tiredness in my legs with light to moderate exertion. I am on Xarelto for the AFib, and about 2 months ago my cardiologist decided to "tweak" my pacemaker to give me a better quality of life. He had the Tech increase my PR to 70, and initially I thought things were somewhat better. But overall, I feel that my bad days are more than before the increase. Some days, I completely flop in a nearby chair just after walking across the floor. I appreciate your thoughts on this. By the way, I am 82 years of age.


4 Comments

Heart Rate setting

by Old male - 2022-07-25 21:40:15

No St Chas   I have had an ICD for 8 yrs. due to Vtac.  Low Ejection Fraction 25 last test and HF diagnosis.  Developed Afib about 4 years ago and like you, take  Xarelto.  Some days I have the low energy tired legs and SOB especially if I bend over to pick something off the floor or ground.  Since most here have pacemakers, some might not be aware that ICD's are set to pace also. Mine started at 60 bpm early on then increased to 70 and set to 80 bpm the last 3 or 4 years.  Most of the time no problem as I manage to stay active.  Just the occasional bad day.  

Heart rate setting

by AgentX86 - 2022-07-25 21:41:12

Your PM should be set to what makes you feel good. He probably raised the rate to try to "out-pace" your Afib.  Sometimes it works, usually not, though.  Throw in a beta blocker and there is more of a chance.

The bottom line, though, is do what  makes you feel good.  If you're not there, have another go at it with him.  It may take a while or there may not be an easy solution for your AF.  Do what you need for the best quality of life. That's what it's all about.

Base rate setting

by Gemita - 2022-07-26 07:53:15

No St. Chas, you ask what factors determine where the pulse rate (Base Rate) is set?  In my experience. our age, heart condition, other health conditions present and any symptoms we may have from our atrial fibrillation (AF) will largely determine where the Base Rate is set and what other adjustments to our pacemaker settings may be needed.  It will be trial and error until we find the right combination of treatments to suit our particular needs.  As both Old male and AgentX86 suggest, if you feel well with a particular setting, then that is clearly the right one for you.  

Symptoms like breathlessness, dizzy spells, exhaustion/fatigue, chest discomfort could all indicate that your heart is struggling to keep up with your activities and at this stage your doctors may use a combination of treatments to try to improve your quality of life.  Treatments could include a change in medication, adjustments to your pacemaker settings and perhaps some cardiac or pulmonary rehabilitation as well as other lifestyle changes.  There are many tools in the cupboard that can be used to help with our symptoms caused by AF.

My Base Rate was increased to 70 bpm because I had bradycardia induced arrhythmias.  At a higher Base Rate setting my EP suggested that this might help outpace my slower, irregular arrhythmias, like benign premature ventricular contractions and premature atrial contractions, the latter would frequently be a trigger for my AF.  To some extent a higher Base Rate setting has been very helpful in controlling all my arrhythmias, but it may not work for everyone.  Have a look for other triggers for AF including caffeine, alcohol, sleep apnea, electrolyte and thyroid disturbances, high blood pressure and many many other health conditions and get these controlled also which will help reduce your AF episodes too.  

I wish you well

Heart Pulse Rate Setting

by No St. Chas - 2022-07-26 19:10:59

Thanks for all the kind responses to my inquiry. I do have high BP controlled and Obstructive Sleep Apnea (I use a BiPap machine nightly. Based on what I'm hearing, I will see my Cardiologist soon. Thanks!

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