Continued symptoms while exercising

I'd appreciate any thoughts on this. Had a pacemaker installed in June after being diagnosed with level 2 heart block. I only experienced "heart drop" during cardio (running, elliptical, etc) and only after reaching 140 HR.

Now trying to recover my cardio capacity post-PM. When attempting to run, I experience 5-6 "heart drops" over the course of the first 5 minutes. They taper off after 10 minutes. I find it necessary to engage in a long, slow warm up so that these events don't occur at high heart rates (and which are super alarming: drop from 140 to 70 HR).

This is AFTER a cardiologist adjusting the PM settings. It's better than before but I guess my questions are these: is this normal? is this the best I can expect?

2 Comments

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by Tracey_E - 2024-08-25 11:44:34

If your upper limit is 140, then your pacer will only pace the ventricles up to 140. If your atria is going faster than that, the ventricles can no longer keep up and if you are working out, it does not feel good. They should be able to raise your upper limit higher.

If you are dropping suddenly from 140 to 70, that's the pacer thinking you are in afib so in order to keep your rate down (which is what happens in afib), it's putting you in an artificial 2:1 block and only pacing every other beat. If we are simply working out, not in afib, it's a bit like hitting a wall. This can be turned off. 

It's normal to take a few tries to get the settings right, esp if you have a doctor that doesn't have a lot of active patients. If they try again and it's still not right, ask to get on a treadmill while on the pacing computer so they can adjust real time. Some doctors are hesitant to raise the upper limit too high, so the treadmill is also a good way for them to see how you do with the higher rates. 

Long way of saying, no that is NOT as good as it gets. Your settings just need more adjusting. 

It's hard on the body when the heart isn't in sync because you are at your upper limit, and when your rate suddenly drops. It's better to not push things until the settings are adjusted again. 

Rate drop from 140 to 70

by Rch - 2024-08-27 03:40:27

Hi Kimbala

Your pacemaker was probably implanted for symptomatic exercise-induced Mobitz type II 2:1 AV block, and is probably in DDDR mode. If your ventricles are beating on their own at higher atrial rates during exercise, when you develop the 2:1 block at HRs 140, the pacemaker has to fill in the block. If the pm doesn't capture the ventricles during the block, your rate will drop to 70. So, it might a failure to capture among other possibilities.

Another other possibility is as Tracey mentioned, if your ventricles are tracking the atria at higher rates, perhaps the rate exceeded the ATR trigger rate of 160, and a mode switch might have occurred to slowly drop you down to the fallback rate of 70 ? 

In any case, please discuss this with your Cardiologist before doing any heavy exercise! Hope you will get an answer soon! 

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