My device was implanted in Feb. '22.

The rate Response setting has been set off. The heartbeat settings are 60 low, 130 high.

when I walk fast at a pace when earlier(pre-pacemaker) the heartbeat would have exceeded 130, I get out of breath with tightness in the chest, but the heatrbeat is only around 60! After resting a while, when the tightness in the chest eases, the heartbeat measures arond 100 which seems normal. What causes the artificial situation of breathlessness and tightness in the chest but heartbeat only 60?  Is the pacemaker telling me to slowdown?  


Could be an easy fix

by IAN MC - 2022-09-13 12:41:46

A heart rate which doesn't increase as it should  when you exercise is a classic case of needing to have Rate Response switched on.

An inadequate heart rate could explain your symptoms . Give it a go and see how you feel.

Your pacemaker is probably telling you that it needs adjusting.......then you will have no need to slow down !

Best of luck


Give us more Bio

by Rch - 2022-09-13 13:19:26

Hi, please tell us what the indications for your pm were. If your pre-pacemaker HR would go up to 130 on exertion and now only to about 60 with symptoms, you may have developed a rate related 2 degree AV block ( Mobitz Type II) which reverts to normal conduction when the rate slows down. I'm just guessing! That's exactly what I had, and I was able to discern that on lead II on Kardia mobile. On treadmill my the AV block progressed to high grade prompting a pacemaker dual chamber Boston Scientic Accolade. My basal rate is also 60 and MTR 130 like your's. I'm not pacemaker dependent nor do I have CI. Nonetheless my rate adaptive mode is on, and may be yours should be too. But again, please give us more Bio if you can, so people on this forum can give you their opinions. 

heartbeat setting

by mahendas - 2022-09-13 15:48:24

Thanks for your comments, Ian and Rch.

I will be 85 next month..

My indication was :

Predominant 2:1 AV block
Right bundle branch block

I am fitted with AZURE XT DR MRI from Medtronics.

Before pm, I regularly walked 4 miles a day, finishing 4m in 1 hour.; played 18 hole golf walking, and did other exercises. Although I never checked my heartrate, quite likely, it went above 130 during these and other excercises.

After pm implant, I have breathlessness and chest tightness symptoms after half mile of walking at the 4m/hr pace. In this condition, my heart rate is about 60, going up to about 100 after a minute of rest.

At a lower pace, I can still walk longer distances.

My surgeon says it has nothing to do with setting.

A couple months ago we tried turning the RR switch on. After a week, back to off because it did not help.

Makes no sense

by Good Dog - 2022-09-13 17:17:50

What you are telling us makes little sense to me. Maybe it is just me?

If you were diagnosed with a 2nd degree block and had no symptoms, then why would you need a pacemaker?

If after receiving your PM, you suddenly have symptoms, that makes no sense. The pacemaker does nothing (that I am aware of) to cause the symptoms you claim to have. The PM should simply be tracking your heart rate and kick in as needed. If you had a 2nd degree block before the PM and had no symptoms, the same should be true after the PM. The PM should fix the block and remedy symptoms you may have had. At least to a large extent. So it sounds to me like you need the PM and the rate response turned-on. However, something is wrong if rate response did not help. Perhaps it was not adjusted properly for your activity level. It also could be that the lead moved, but that would have likely occurred long ago; within a month or so after the implant, not recently. If a lead moved, that could definitely cause the symptoms you describe. They can take an xray to check the lead and/or turn-on rate response and try optimizing it. That may take multiple attempts. In any case, we cannot and should not try to diagnose you problem here. I am just offering possibilities that you can ask your Doc about. You definetly need to get checked-out. If your Doc can't fix the problem, then you may need a 2nd opinion. You should pursue this to get it fixed so that you can get back on-track so that you can be active and feel well again.

I wish you the very best!



After a week, back to off

by Persephone - 2022-09-13 17:38:42

Perhaps a week was simply not enough time to adapt to and assess the results of the change.

Exertional Angina?

by Rch - 2022-09-13 18:37:18

Hi, if the Surgeon says the pacemaker is working fine, it should be able to pace your ventricles through the 2:1 AV block. However, you may feel the ventricular kick but the heart rate should stay the course. I'm wondering whether you are starting to develop exertional angina. So, I strongly urge you to talk to your Cardiologist before resuming exercises. 


by AgentX86 - 2022-09-13 20:25:23

What you say makes absolutely no sense.  When you exercise, your heart rate doesn't increase above 60bpm, then after, your resting HR goes to 100bpm? But your pacemaker is set to 60/130?? How are you measuring this?

That reminds me of the old joke... If your nose runs and your feet smell, you're built upside-down.

makes no sense

by dwelch - 2022-09-20 08:25:21

Sorry we are all saying this.

The pacer fixes heart block, it is a trival fix.  Fixing heart block makes your heart work normally.   Some level of exercise before (assuming complete heart block or some level) took more work on your heart, with a fixed heart that now works normally, it has to work less so it does not have to get such a high rate.   You can do more with less.  I dont see any need for rate response for heart block, that makes no sense to me.  the pacer is working every single beat to fix the block, at whatever rate you are operating.  If you were fine before then you dont need a bump in your rate.

I think you may still be getting used to your device.

Now...have they put a halter on and recorded  you for a day or few?  They can do that and see what your heart and device is doing when you are walking and golfing.  If the device was simply not working then it should feel like pre-pacer, I assume you have not been paced long enough to truly get used to it.  And being level 2 it is not 100% of the time like myself and a others that replied here.

Ahh and as AgentX86 is asking, how are you measuring this.  Dont use a watch or other electrical device, you can use a clip on the finger infra red deal or count a full minute against a second hand, no shortcuts, full minute. 

Maybe you are bumping up against your upper limit and then that would make sense that the pacer is limiting you.


You know you're wired when...

You have rhythm.

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