Newbie needs help

Upper Limit

by doublehorn48 - 2023-06-06 11:13:03

At your age your maximum upper range is 141. If they raise your upper range above 160 would be futile. My upper range has been set at 160 since I was 38. I'm now 74. I'm as active as the next guy and I don't hit 160 anymore. Setting your upper range higher than it is isn't going to help you. I'm not a cardiologist but this setting isn't the problem.

Raising your maxHR is unlikely to help

by crustyg - 2023-06-06 11:28:11

Pardon me for being a downer, but I really don't think raising your maxHR above 160BPM will make much difference and could make you unwell.  Blood flow to the heart *only* occurs when the heart muscle is relaxed (diastole).  Blood flow requirement (oxygen demand) increases as HR increases.  You can see that increasing HR produces an uncomfortable situation where oxygen demand increases but oxygen delivery decreases.  For most athletes, maxHR doesn't need to be more than 165-175BPM, and probably a little less for older athletes. Athletes increase cardiac output by increasing stroke *volume* as much as by increasing stroke *rate*.  You no longer have that ability.

Post AV-ablation you've lost A=>V synchrony, so most of your ventricular beats will have reduced filling - AgentX86 says about 20% reduction in cardiac output per beat compared to normal A-beat filling ventricles.  From my own experience of switching from a junctional rhythm to A=>V sync, I'd say that's about right.

Your PM can't sense anything useful from your heart to tell it when to increase your vent rate: how well tuned is your Rate Response (the R on your DDDR pacing mode)?  Do you achieve maxHR easily?  Too easily?

AV Node ablation

by Gemita - 2023-06-06 11:57:27

I am sorry to hear of your frustrations.  Atrial Fibrillation (AF) is a pest of an arrhythmia and difficult to control.  I wonder if your main problem is an active atrial lead?  You don't tell us whether your AF is intermittent or persistent/permanent?  I have presumed the latter since you have had an AV Node ablation?

An AV Node ablation is done when all other treatments have failed to control AF.  It effectively disconnects the upper chambers of the heart from the lower chambers, preventing the fast, irregular heart beats of AF from getting through the AV Node to push our ventricles too fast which would be dangerous. This ablation does not however stop the AF or any other atrial tachy arrhythmia which will continue in the atria.  After an AV Node ablation we would become pacemaker dependent.

Since the whole purpose of an AV Node ablation is to isolate your top heart chambers (atria) from your lower chambers (ventricles), the main pumping chambers of your heart, I do not understand why you are still affected by your fast atrial arrhythmias which should be confined to the atria?  The AV Node ablation should have given you respite from your symptoms?  If this hasn’t happened, perhaps this is because you might still be pacing in the atria intermittently, then rapidly switching modes to avoid tracking a fast arrhythmia?  Something to ask your doctors about?  You could ask specifically whether your atrial lead has been switched off? 

After an AV Node ablation, most patients would pace only in their ventricles (either the Right Ventricle or both Right and Left Ventricle, depending on their device).  From your comments it seems you might still have a working dual lead pacemaker which might be tracking what is happening in the atria?  If episodes of Atrial Fibrillation are still affecting you after an AV Node ablation, then you want this stopped.  You need to know whether the lead to the right atrium is still in operation and if so, what settings are in place and could these settings be causing your symptoms?   Does that help a little or have I confused you?

By the way, welcome to the Pacemaker Club!

newbie needs help

by Old Rocker - 2023-06-06 13:59:24

Many thanks for your responses, most interesting and informative. Just something i'm not quite grasping. I was originally informed by my consultant that following my procedure I would get back to my previous performance levels. He was made well aware of my lifestyle.

A year ago I was weight training seriously, one hour, three times a week. Additionally I was cycling and running with no problem.

Now post procedure and after a year I have finally got back to my weight training schedule exactly as before. However, aerobically, nowhere near. So then exactly what is keeping me from attaining my previous level.

AV Node ablation

by Gemita - 2023-06-06 16:05:52

Old Rocker:  You ask "So then exactly what is keeping me from attaining my previous activity levels" following an AV Node ablation/pacemaker implant?  

With respect, I would refer you back to what has already been said.  Personally, I would want to establish how many active leads you have?  Having an active atrial lead in my opinion following an AV Node ablation might complicate the management of your settings and lead to pacing difficulties and to more in the way of symptoms.  But you need to find out what is set up?  We had a member who had three leads (two to both ventricles and an atrial lead which was still active following her AV Node ablation).  I recall there were many pacing problems and she was complaining of still feeling her AF. 

No one can predict how well we will do following an AV Node ablation and pacemaker implant.  Some patients do extremely well with steady ventricular pacing only and without the support of their upper chambers which can provide up to a third of our cardiac output I believe.  Exercise capacity may be improved further once the symptoms of a fast, irregular rhythm like AF has been prevented from passing through the AV Node to affect the ventricles.  Tachycardia and irregularity of rhythm can make me extremely breathless for example and unable to exercise, so I can imagine what you are going through.

After a successful AV Node ablation I would have expected less in the way of AF symptoms, if this is what is still happening?  Good luck for your appointment

🎸

by Lavender - 2023-06-07 08:13:32

Lovin your name-motorcycles, guitars and keeping fit will keep you young!  
 

When you have your check up, be sure to be as pleasant as possible but persistent in asking your concerns. You can't be the first person they ever dealt with who's had your issues with aerobics. 

newbie needs help

by Old Rocker - 2023-06-07 09:45:00

Thank you Lavender. Yes been into motorcycles since I was 16 and currrently enjoying the IOM TT races. Also guitars, played in a Shadows Tribute Band for years till AF messed up the job and since childhood have been into health, fitness and nutririon, which is why I am so frustrated at the moment.

Al least I now know my problem, ignorance, lack of knowledge. I saw a consultant one year ago and since then have seen no doctor or consultant. I have visited the pacing clinic twice, been seen by a young girl who said my pacemaker was working as it should and could not answer any of my questions. I only know I have a dual chamber pacemake and that is the total of my technical knowledge! The previous answers given on this forum I simply don't understand due to my ignorance of the subject.

Coming on this forum I now realise that I need to embark on a comphrebsive learning program and educate myself on Pacemakers so I can then ask the appropriate questions and more importantly understand the answers.

Old Rocker

by Gemita - 2023-06-07 13:07:57

There is so much about pacemakers, settings and arrhythmias that I don’t understand either.  My pacemaker was implanted in 2018 and it has been an uphill struggle to learn how it works, what it can and cannot do for me.  I also have AF and I know how difficult it is to get my settings adjusted to suit me when I go into AF, but you shouldn’t be having this problem after an AV Node ablation.  

Most active members get their settings adjusted while working on the treadmill with a pacemaker technician or the pacemaker manufacturer technician.  Members usually have to return to clinic many times before they are happy with their settings.  You could ask about treadmill exercise testing during your next clinic appointment.  That is the best way to make your team understand what you can and cannot do exercise wise.  Tell them how important exercise is for you to stay well.  You may need to make an appointment to go back for this test.

Hopefully you will find caring support here.  We try our best to keep our answers simple, but pacemakers and electrical disturbances of the heart as you are discovering are complex and not at all easy or straightforward to write about or to understand.   I often struggle to understand my own condition and pacemaker but we learn by asking questions and reading the answers and since the same questions will come up time and time again, we will soon learn.  Just be patient with yourself and with those who are trying to help. 

I agree with Lavender, go to your appointment and be as pleasant as you can.  I wouldn’t try to go into battle with your clinic technicians.  Get them on your side and they will be far more likely to want to help you.