Medtronic settings for walker/runner/swimmer

Hi everyone, new to the forum and grateful for any advice on this issue. Reposting as i had this on general, but realized its probably more exercise related.

I am a very new pacemaker owner, having only had my device 2 weeks today. It is a Medtronic Azure XT DR MRI Surescan.

I have a two lead device treating a "sick sinus syndrome" that was diagnosed in a regular checkup (25 bpm HR) and a PM fitted immediately.  I also have an exercise induced right bundle branch block, that i have had as a teenager (normal 42-45 RHR) that has not caused me any issues. In all other ways heart is healthy. I am/was reasonably fit, run anywhere from 5km to half marathons and swim 2-3 km per week, plus peloton.

Device is set with a low HR of 50, Sleep mode of 45 and a "high" of 150, not exactly sure what the high end means/does. My garmin data shows that pre-op on walks my HR would normally climb to 110-130 and anywhere from 150 to 175 on runs, around 42-45 RHR.

I went for a walk today (5km) and about 10 mins in I felt a thumping and tight sensation in my chest, and my HR shot straight up to 150 and flatlined at this number. I was not out of breath, and slowed down a little which made the chest feel better, but my garmin recorded a flatline HR of 150 the rest of the walk other than when i stopped for a few mins. ( i wish i could post the pic!).

Quite concerning, not sure if it is settings ( Rate response?) or not responding correctly to input from one of the leads, or a problem with lead placement.. Would appreciate advice from anyone who has experienced this or similar and/or has knowledge of the Medtronic device and its best setup for those who exercise multi sports quite a bit. 

3 Comments

Sounds correct

by crustyg - 2024-09-30 02:26:29

If you have Sick Sinus then you will have Chronotropic Incompetence - inability to raise your HR appropriately, so will need Rate Response enabled.

Once your leads have bedded in a little more (typically six weeks) you should have another EP-tech session and get your maxHR (the 'high' that you mention) increased as 150BPM is too low for someone of your age: 165-175BPM would be more realistic.  Going from resting to maxHR for 1-3hrs should be OK if your coronary arteries are clear and your heart muscle is healthy.

Swimming: you've probably been warned off *all* swimming until the incision over your PM is completely healed.  You may find that your device accelerometer needs to be set to be fairly sensitive to small movements *and* have a high factor driving your HR for swimming, as most swimmers don't have much upper body acceleration during this.

Running should be no problem.  Static bike work (your peloton): you've probably got the wrong PM for your condition and this activity and may experience a lack of HR response as your condition worsens (which it probably will).

Exercise tachycardia

by Xtrabeat - 2024-09-30 12:30:13

I had very similar symptoms to yours. I guess that a fit person walking 5km would not expect their HR to go up as high as 150 unless there was a pretty steep hill. It is notable that your HR was also max PM rate and presumably you have not had chest pain before? I am wondering whether you might have an exercise induced PMT. Do you know if rate response is turned on? RR has various settings which follow predefined algorythms triggerd by a number of factors (like movement but also chemical changes in the blood) and it could be that this is too sensitive. I think t is still very early days so would agree that letting things settle a while longer might be sensible - but if it recurs maybe get an earlier appointment with the EP.

Thanks and links

by CrocG - 2024-10-01 20:53:44

Thanks everyone. I found the following info on line which has been helpful. Going in to get reprogrammed on Monday. Hope this helps someone else.

https://www.cardiocases.com/en/pacingdefibrillation/specificities/pm-programming-exercise/medtronic/rate-adaptive-pacing-medtronic

https://www.medtronic.com/content/dam/emanuals/crdm/M994942A001A_view.pdf

https://pept.org/res/slides/Lecture%2013%20Rate%20Response%20Modes%20Handout.pdf

 

 

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It may be the first time we've felt a normal heart rhythm in a long time, so of course it seems too fast and too strong.