PM Setting Changes

Hi everyone! I have an appointment Friday with my Cardio to discuss changing my PM settings. I have thought long and hard about this as everything is going ‘OK’ and I wasn’t sure if I wanted to mess with them. BUT I think the time has come. I have AV Block 2nd Degree Mobitz 1. My hr mostly drops during exercise. I have only had the PM for about 1 ½ years so this is all still new to me. They had turned on my rate response to a low setting early on as I was still having sob going upstairs. That helped a lot.
I had been limited to exercising in a pool as I had a torn Achilles tendon. Now I am finally on land. I have a lot of weight to lose and have been trying to increase my routines. I started walking – which is fine on the ankle – but I feel like I ‘hit a wall’ on hills and such. I have been walking now for a couple of months and even completed a 5k walk which was a lot of fun. I have seen some improvement on my breathing but I think I should have had more during this time.
It is difficult to take my hr as I can’t get a hr monitor to work. I did buy a pulse oximeter so I know that my oxygen level is good even though I feel out of breath.
I’m afraid to have them change the rate response setting again as I don’t want issues with that. I think that my top setting should be raised. I am set to 120/60. My resting hr averages 60 (I pace about 90% in the ventricle). I am 49 and when I calculate my max hr I get 174. For exercise it is showing easy as being 128-145, anaerobic training at 156-162 and max 162-174. But I can’t get above 120, oh sometimes I hit 122-3 but it doesn’t last.
In the past, before I was really training on land where I have an impact, my cardio told me don’t worry about numbers just get to sweating. That is all well and good but I can’t seem to get into a ‘fat burning’ zone. And I have a lot of fat to burn.
The PM has been great for me as I can finally do some exercise and see some improvement but I think I am at the point where I need more. I had always thought that I wasn’t able to move more because I was out of shape/overweight and I got discouraged too soon and quit. BUT now I know it was my hr that was dropping and not allowing me to move more.
I would like thoughts on this from others that have been in this situation. Do you think I should mess with the rate response? Or push for a higher max. Any thoughts on what I should ask for as the top number? (I know the doc has the final say!). I don’t have any other health problems and am trying to avoid them by losing weight. (Primary suggested lapband if I don’t get down another 15-20 in the next several months and I would rather do this on my own)
Thanks in advance for the help! I love this site and while I don’t post much I read it almost daily and I have learned so much!
Sandy

6 Comments

Exercising

by Pollyanna - 2010-07-07 06:07:23

Hi Sandy,
I am not sure I can help much as I am in a very similar situation to you. Since I had my rate response turned up three weeks ago there has been a lot of improvement with everyday activities such as going up the stairs without getting short of breath and I do feel more awake! However like you I am trying to get fit and finding it very difficult to exercise. My pacemaker is set between 60 and 160 and the rate response is now on high. I swim twice a week and run or cycle on the other days. When I start to run (more of a "jog" really) my heart rate rises to the 90's and then seems to stay there, I quickly become exhausted and have to stop. As soon as I stop my heart rate jumps up to the 150s or 160s and I feel dreadful. When I swim or cycle my heart rate just doesn't get beyond the high 90's and I am very quickly fatigued.
The only thing I can suggest to you is to ask to have a treadmill test as this will show what is happening when you are trying to exercise.
Also I have read some posts on here about the different types of rate response sensors that pacemakers have and that some are better for more active people. Maybe someone else will post some information on this.
Sorry I couldn’t be much help and hope you get some answers soon,
Best wishes
Pollyanna

Thanks!

by Rubies61 - 2010-07-08 01:07:29

Thanks Pollyanna for your imput - I hope that they get your settings correct soon! I will as for the treadmill test if they give me problems.

Thanks Frank for your reply. The diagnosis I gave is what is printed on my release forms. Not sure if it is 100% correct. My understanding is that my heart rate is fine until I exercise then I skip beats, the harder I exercise the more skipped beats occur between each beat (I hope that makes sense). My resting rate was ok and I am ok at night - no drops. My EP, the PM tech and my Cardio all voted for a low rate response. It did help as far as going up and down stairs - no sob.

But now that I can finally really truely exercise it is an issue. I think I will have them leave the rate response as is for now and push for the higher upper limit. I don't want them to do too much at once. From my readings of this site they can cause more problems that way!

Thanks for sharing your knowledge. I'll let you know how it all turns out!

Sandy

Not doing too much at once

by ElectricFrank - 2010-07-08 02:07:01

The only problem with this approach is that many of the settings are interdependent. Here is the problem. If the upper limit is set low, then the rate response also must be set low. Otherwise, the rate response initiates the undesirable limit response and the feeling of SOB.

Actually the best way to determine the proper settings for something like yours is for them to schedule a treadmill during the programming. You just start with the simplest settings like I mentioned, increase your HR on the treadmill and see how it reacts. If it drops inappropriately with exercise level it is easy to add Rate Rate Response and adjust it to give the best results.

Even without the treadmill there is no reason for you to have to live with new settings if they don't work. What I actually did was to schedule an early morning programming session where my requested settings were made. I had an agreement that I would engage in some activities to test it and come back if it didn't work. After a fast 3 mile walk where I felt the best I had since the pacer, I drove out to the desert and climbed a 400' hill and all still worked out fine.

I then reported back to the office for a quick interrogation of the pacer which showed no problems either.

Keep in mind that the medical types will always chose the quickest, CYA approach over the one that makes live enjoyable.

best wishes,

frank

Settings are messed up

by ElectricFrank - 2010-07-08 02:07:16

With "heart block" and no sinus arrhythmia there is no reason why you should have rate response turned on. It is just interfering with your natural pacing. I had the same problem early on and after a bit of a bru ha with the doc I got it set right.

Based on simple heart block what you need is:

Mode: DDD (this lets the pacer use your natural atrial rate to control pacing. RR is off)

Upper pacing limit: At least 150 and as you mentioned maybe even higher.

It is the 120 upper limit that is causing your problem. When your HR reaches 120 the pacer enforces the limit by skipping beats. This is why you see your HR suddenly drop when you hit 120. If you keep pushing on you have an erratic beat at a rate too low for the exercise level. Naturally you will be out of breath.

I live in the desert and we have high winds in the spring. I was having problems just walking into the wind. Being an electronic engineer I download the technical manual for my Medtronic pacer and studied the situation. I told the doc I wanted my limits set to 55-150 and no RR. At the time I was 75yr and he was really reluctant but finally we got it done. I don't push myself to 150, but I want it available if I need it. Since then I camp and hike in the Sierra's and even hiked around at 13,000' in the Rockies.

hope this helps,

frank

Thanks again Frank!

by Rubies61 - 2010-07-08 07:07:11

Thanks again, I will see what the cardio says and then suggest depending offer your suggestion. I am visiting his main office (I usually see him when he has hours at my primarys location) and he has the treadmill there. My EP and the PM clinic are across the street at the hospital so it shouldn't be too hard to get them to do what you suggested.

For the most part they seem to listen to what I say so far and have always asked me how I am doing, I just found myself exercising more often and notice the issue and I didn't want to wait until October for my regular clinic and cardio visits.

Sandy

Good idea

by ElectricFrank - 2010-07-09 02:07:11

For some reason they tend to think they are doing their job so long as we stay alive. I have a hard time convincing them that for me a good quality of life is more important than length.

My GP tried to scare me by saying that with my cholesterol I have a 25% chance of dying in the next 10 years. My response was that at 80 yrs that sounded pretty good to me!

frank

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