Best setting for runners

running

by Tracey_E - 2024-09-08 14:42:21

How high does your rate get when you run? If it's getting higher than 160-165, you might want to ask them to give you a higher upper limit so you have a cushion. 

Have you tried it with rate response turned off? Not sure if that's what you meant when they turned off minute ventilation. With heart block, in theory your rate gets up just fine on its own so it's possible the pacer is competing with your natural sinus rhythm and rate response is causing more problems than it's fixing.

Have you gotten on a treadmill while they watched with the pacing computer? Or wear a monitor for a few days and go for a couple of runs? Anything to give them more data exactly what your heart is doing. 

Have you had an echo to make sure your heart function hasn't changed? It's probably just your settings, but it's good to rule out anything new going on. 

Is there a sports cardiologist in your area? Go higher up the chain at Boston? 

If you feel good, don't worry about how much you are pacing. There is no right or wrong number. Most of us with heart block eventually pace ventricle 100%. Gradually pacing more over time is normal. 

running

by MamaJ - 2024-09-08 14:57:31

Thanks for your comments/suggestions Tracey_E. My main concern is how horrible I feel running. I can barely run 3 miles. As a reference, I've been running my whole adult life and in the way-back machine have completed marathons, etc. 

My heart rate typcially ranges between 130's-140's running with upper 130's most common for a slow, easy pace, which is all I can muster these days. Yes, the rate respose setting is currently turned off.

Yes, I have run on the treadmill but they did a traditional stress test and would not allow me to run under normal circumstances for a few miles to see what my heart is doing while running normally. It did not provide any insights. 

I have a full cardiology work-up every year, to include an echo, due to family history aortic dissection, but they may be reviewing it with a different lens so plan to bring this up at my next cardiology appointment. A sports cardiologist is a good idea to look into.

Tracey's suggestions will inform your next settings

by crustyg - 2024-09-08 18:14:58

I used to be a runner (before and after PM implantation) and never needed the accelerometer sensitivity to be increased from factory default (8) to reach maxHR with my BostonSci Accolade to overcome my SSS+CI.  Once I was paced the horrible air-hunger that I felt when running uphill or swimming hard disappeared.

*IF* I understand what you're saying, you aren't ever reaching 170BPM.  If that's the case then you have more than HB, you're developing SSS+CI, in which case you need RR turned back on.  If you only run, then MV is probably not important to you.

The Bruce Protocol treadmill stress test is designed specifically to be open-ended and yet not take all day (it's basically impossible to sustain a running pace as the gradient shoots up beyond 10%), and if you didn't achieve a really high HR towards the end then you've already proved that you have CI.  The test is very unphysiological but it's not designed to be a 'bleep test' on a treadmill.

Help us to help you: please fill in more of your bio, model of PM etc., but not serial number.  Don't be shy!

There are always different levels of skill and expertise in those who advise us.  Where I live, the Boston Sci reps are extremely good, knowledgeable, helpful and willing to share their expertise.  But athletic PM patients are still in a small minority - perhaps 10% of the PM population, so your EP-team may not have a lot of experience with very active PM patients like you.  With luck you can learn from each other.

Adaption

by piglet22 - 2024-09-09 06:28:55

I too used to exercise a lot, more on the bike than running, all with a pacemaker.

The pacemaker gave me back the ability to carry on normally.

But age and a deterioration in my condition - Mobitz type 2 - means I just can't do it any more and no amount of tweaking is going to give me back what I used to do.

Now 100% paced both chambers, I have to do what the PM decides. In any case, I can't see my health trust having the resources to spend much time on fine tuning.

Luckily, my EF is still 69% so something is still working 

Adjusting your device is no different to adjusting medication - only more costly in time

by crustyg - 2024-09-09 09:49:36

Piglet: you've expressed your frustrations with your EP-service before.

I'd suggest that it's no more unrealistic for you to ask for your device to be adjusted (or tuned, if you prefer) than it would be to ask for any heart-related medication to be reviewed.  Clearly it's more costly (for you and the Trust) to accomplish this, but, as we can agree, PM's are no more fit-and-forget than heart medication is set-once-and-leave-forever.

Some patients require more follow up care/time/resources than others: have you any desire to get your device changed, or is this something that you've come to terms with as probably having no useful benefit?

Boston Scientific and Minute Ventilation

by Selwyn - 2024-09-09 17:58:43

I have been getting my Boston Scientific adjusted for exercise.

My electo-physiololgist, with years of experience says the Minute Ventilation rate response should only be used for cyclists. If you apply the minute ventilation rate response it knocks off the accelerometer settings. By chance, after my flutter ablation someone set up my minute ventilation - it did worsen my ability to exercise. The problem lies with what the Boston Scientific manual says,"the blended rate will always be equal to one of the rates or between the two rates. Whenever the accelerometer is greater than the minute Volume the sensor blending will be 100% MINUTE VOLUME BASED". - this probably explains why you have to breath so hard.

I would urge you to have the accelometer rate response turned on to a reasonably fast onset. To get the upper rate limit to your maximal recommended level ( if you exceed this level you may find your pacemaker sends you into a 2:1 block of something similar), and sack the ventilation response.  You can also check the atrial blanking period- it may be possible to shorten this to give you more of a response without getting feedback!

For most of us that exercise, the minute volume setting is an impairment.

MV works well for swimming

by crustyg - 2024-09-10 05:07:15

The single accelerometer in Accolade is positioned so that it responds to forward/backward movement of the chest.  It's quite obvious looking at my HR data from swimming - a big spike as I push off for the first time, then HR builds from MV.  I suppose if I worked on my tumble-turns I'd get some accelerometer assistance for my HR.

One of the Boston Sci reps that I've worked with is a good swimmer and he's quite clear that MV can definitely produce useful RR for swimmers, as well as the benefit for road cyclists which was the primary market that Guidant was aiming at when developing MV.

Boston Scientific and Minute Ventilation

by MamaJ - 2024-09-17 15:06:49

Thank you for your feedback @Selwyn. I do sometimes cycle via spin class and occasionally get my bike out but running is my exercise of choce so if I can feel good doing that, I can live with things not being perfect on a spin bike. I may have them shut off MV and focus on the accelerometer. I haven't tried that yet!

Thanks for your comments as well @crustyg. My heart rate did increase while doing the treadmill test, but the Boston Scientic rep present didn't glean any insights through the test. I've not been diagnosed with SSS or CI. That is correct that I don't typically reach 170 bpm while exercising. My heart rate increases to 135-145 running typically. Occasionally my heart rate will rise between 150-160 exercising, hence the 170 setting.