What is rate response? Off/On?

Okay, I am a newbie. 3 weeks since my pacemaker implant. I am trying to decipher all the jargon... what is "rate response"? And why would it be turned off or on? Sorry to be clueless, if there is somewhere on the website that will explain this please direct me! Thank you.

It does seem I am not alone in not receiving adequate educational information about this technology I have in my body. What is the deal anyway? My hubby is a heart patient (cholesterol/blockage problems) and they have support groups at the hospital, education nurses, etc. But nothing for pacemaker folks! Grrrrrr.



by ela-girl - 2008-03-21 11:03:28

Hi there, Swedeheart, and welcome!

Isn't EFrank's description of rate response great?! There are a lot of great people on this site, so always ask away. There is also a "search" feature in the gray upper right hand corner of the page....so, you can always search for things on the site. Usually, most things have been explained many times before and many posts will come up to read. Just an FYI! But that doesn't mean you shouldn't post your questions!!

It never ceases to amaze me how little us pacemaker folks get in terms of information from our providers. I guess since we're not doctors, they just think they can do what they want to us because they know best and don't have to explain what you may not understand. It's maddening! Thank God for Blake and this site! Did you happen to get a pacemaker booklet at the hospital? Not like those are that great either. You've come to the right place if you have specific questions! We all make a great team here!

So ask away....

Rate response

by ElectricFrank - 2008-03-21 11:03:36

There are several heart problems that make a pacemaker helpful.
One is where our own natural pacemaker is working and responds to activity, but the connection to the ventricles is interrupted. In this case all the pacer needs to do is sense the atrial contraction and the stimulate the ventricles to contract. This is the most desirable because we still have a natural response to exercise.
The other type of problem is where our natural pacemaker isn't providing control so the pacer has to control the atrial rate. Now the problem is how does the pacer know what we are doing and how fast should it pace. In the early days of pacemakers all that was available was to set the pacer to a best guess fixed rate. So most of the time it was either too fast or too slow. Heart racing when relaxing and out of breath when exercising. The modern pacemaker has built in sensors that measure movement and sometimes other things like body temperature, and use them to control the HR. This is called Rate Response. It has to be "tuned" to match our own particular physiology and takes skill on the part of the EP to get it right, but can work nicely.
Now, as to turning Rate Response off/on, we don't want it on if we don't need it. For one thing if our own natural pacer is working then let it do it's job. One common problem is having our own pacer and the rate response conflicting with each other, creating erratic beats. The faster of the two will always win out since a pacer can't slow the HR. So the typical doc or cardiologist who doesn't understand the electrical system of the heart well will look at the erratic heart beats and then speed up the rate response to smooth things out, when actually turning it off is best.
My suggestion is to start by asking for a printout of the pre and post settings at your next checkup. Also ask if Rate Response is on or off, and if on why. If you can't get a good answer ask to have a check up by the pacemaker manufacturer rep who generally understands the whole thing.
It took me almost 6 months to get rate response turned off and only after I made it clear I would see someone else if it wasn't. Now if I ride my exercise bike I get a nice response curve where my HR starts down in the low 70's and gradually climbs to 130-140, and then after I stop slowing returns to resting. It is obvious that I didn't need Rate Response turned on.

I hope this wasn't too long winded. I guess my typing rate response must be on.


Thank you so much!

by Swedeheart - 2008-03-22 01:03:06


Thank you for the great explanation! I am learning so much at this site! It is wonderful.

Thank you too Ela-girl for your response.


by heckboy - 2008-03-22 08:03:21

That my EP initially had my rate response turned on for my first PM even tho he knew I had normal sinus activity. It underscores the need for us to know out condiion and how our PM works so that we can be an active participant in how our PMs are programmed.

Search Feature Oh oh

by ElectricFrank - 2008-03-22 10:03:54

Now you've done it. A search on so of the topics I've commented on will show I don't say the same thing twice!

You've got it right heckboy! We are up against incompetence, being too busy to bother, CYA, and a host of other things. We are the only ones who care enough to get things right. It's too bad with what we pay these guys that we don't get more than we do.

Several of us have mentioned that the pacemaker rep does a better job than most cardio's. One thing to keep in mind here is that medical ethics keeps the rep from making suggestions in the patients presence. But, there is nothing that keeps the patient from asking the rep about something like rate response, getting an answer, then suggesting it to the cardio. Early on my cardio jumped me about doing this telling me I wasn't being ethical. My response was that as a professional patient I have no ethics! Now he leaves the office when I am talking to the rep. The rep and I figure out what to do.


You know you're wired when...

You have a dymo-powered bike.

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I have an ICD which is both a pacer/defib. I have no problems with mine and it has saved my life.