Setting Question

I'm looking for your input. I have a Medronic Adapta rate responsive pacemaker. I'm 44 and very active. My upper rate is set at 160 bpm and my lower rate is set at 70 bpm. I'm thinking of asking my cardiologist to change my settings.

I'm quite restless and have a hard time sleeping. I believe this is because my heart beats so strong and fast while trying to rst. Do you think 60 bpm is too low for a lower limit? I jog, but would like to start pushing myself more. My pacemaker is programmed to reduce my heart rate when I hit my upper limit, which happens more often than I would like. When this happen I quickly loose mt breathe and my legs feel like rubber. I'm thinking an upper limit of 175 bpm would allow me to exercise more. Any thoughts?

Your input will help me have a good discussion with my cardiologist on this topic.

Thanks,

Blake

5 Comments

RR

by Heidiglassmeyer - 2012-05-07 10:05:17

Hi Blake,
We are very close in age and prior to my back issues I was very active. When my upper tracking rate was at 160 I would frequently hit the wall and as you probably know through your own experience it is not fun. I finally convinced my EP to leave my regular range where it was but increase only the RR threshold to 180. After that change my issues went away. To help with sleeping I had my sleep mode turned on and is set from 10pm-5am. Not sure if your PM has that function but something to ask.
Take care,
Heidi

Lower Limit

by ElectricFrank - 2012-05-08 02:05:00

Blake,
I've had my lower rate set to 55 since my first checkup in 2005. The only thing I notice is that if I really relax like go to the hot tub and then stretch out in the recliner to watch TV, I can get into sort of a slow down mode. No problem, just feel like it would be nice to just stay there. All it takes is for me to get up and move a bit and I'm as wild as ever.

I have no problem with sleeping. I've been thinking about having mine lowered to 50.

So 60 or even 55 shouldn't be any problem unless you found yourself feeling light headed on standing suddenly.

I would avoid hitting that upper limit and get the setting increased. The problem with hitting the limit is that right at the time when your body needs the blood flow to support the exercise level, the pace cuts HR down. I can't help but think it isn't a good thing. The symptoms are telling the same story.

frank

Hi

by Karen - 2012-05-08 02:05:55

I have a st. Jude pacemaker. They recently changed my settings from mode ddi to mode ddd and rates to at 140/60. They were careful about the ventricle setting for some reason. Does yours have different mode settings.?

PM Settings Changes

by SMITTY - 2012-05-08 07:05:41

Hello Blake,
I'm sure you know how much of an expert I am on the subject of PMs and settings so I'll give my opinion.

Many times the lower set points on our PM is just an arbitrary number when a low HR due to bradycardia is not the determining factor. I don't recall why you have a PM but my guess is a 60 would be safe and worth a try. The initial setting on my PM was 80 and I had trouble sleeping for the reasons you name and requested a lower setting. Since my natural heart rate was in the mid-50s range I got the 60 and had no problems. Also my sleeping got much better. I have had several different low settings throughout the years and currently are back to my original 80 but no sleep problems now and I don't know why. Could be that I more than half deaf now.

You mention you run out of gas when you are jogging and reach the upper set point on the rate response. If I understand what I have been told about that when the upper limit of the RR is reached it quits trhying to help the heart and you have to rely on the heart's natural PM to go higher. If that is fact then I would say a request for 175 may help.

One other thing I was told about upper set points for RR is that is it is often determined by the formula of 200 - age X 90%. Using that formula your upper RR set point would be 140. However the Dr did point out that formula was just a guide line for him to use until he got to know his patient and how well their heart could handle additional load. In my case the upper limit would be 120, but he said he felt I would be better off with a 110 setting, which is fine because I can never reach that anyway.

I will add there are several things that go into determining upper setting for the RR and they are whether the patient has CHF or not and what they have for an ejection fraction. I do have CHF and my EF is in the low 40s, thus my 110.
Good luck to you,
Smitty



HI

by SUPERSALE - 2012-05-14 11:05:23

I GOT MY PACEMAKER SET ON 60 I HAVE NO PROBLEM WITH IT. IF YOU HAVE PROBLEM WITH YOUR SETTING CONTACT YOUR DOCTOR WILL HELP

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