Chronotropic Incompetence

Hi, I was diagnosed with bradycardia and chronotropic incompetence last May and had a Medtronic pacemaker fitted in June. I was a good club runner and found it difficult to breath when running. Although the pacemaker has solved the bradycardia, I am still having problems when running in that the pacemaker does not usually respond enough to exercise and my heart rate does not increase enough for the effort made. The Technicians are trying to adjust the rate response, but not being used to his situation, having trouble. Current rate is too aggressive so when I exert even a little it shoots up to maximum HR, 175, so I can breathe but tire sooner. Does anyone else have this experience?
Thanks

7 Comments

Do you even need Rate Response?

by COBradyBunch - 2010-05-10 05:05:25

Just wondering, does your HR increase naturally or are you pacer dependent. I had them shut of my RR since my heart doesn't need it... just has to be kept from bottoming out (those 10 second heart naps were making me take unscheduled naps)

brady

by Tracey_E - 2010-05-10 06:05:39

chronotropic incompetence is when your hr won't go up adequately with exercise, so yes it's highly likely the rate response is necessary. Fine tuning it can be a bitc*, as gailie is learning.

close

by Tracey_E - 2010-05-10 06:05:48

I don't have chronotropic incompetence but I've had similar issues more than once over the years, problems working out that my dr never sees and therefore didn't have a clue how to fix. One thing they've done is hook me up to the pm computer while on the treadmill so they can watch exactly what my heart is doing on exertion, then let me try out the setting changes while they watch again. When that didn't take care of it, my St Judes rep researched their case studies for similar documented cases. One time even that didn't help so they faxed all my records to the St Judes engineers who made me a case study. They came back two days later with recommendations.

Keep at it! When we have a fairly rare condition we can't really hold it against the drs that they don't have the answers immediately, but the answers are out there if they're willing to dig a bit for it.Good luck.

I need one

by gailie - 2010-05-10 06:05:56

Yes, before the RR was increased, my HR would sometimes go up, and other times would only go up a little, so I was making a lot of effort and getting nowhere. Its just getting it adjusted right. I wondered if anyone else has been diagnosed with chronotropic incompetence as this means my heart doesn't respond appropriately to increased metabolic stress.

chronotopic incompetence

by golden_snitch - 2010-05-11 03:05:58

Hey,

I know exactly what your talking about. I have chronotopic incompetence, too, and am paced 100% in the atriums after complete sinus node ablation and while being on meds to treat some other arrhythmias. When the upper rate is set at the max of 185bpm, I get tachycardia whenever I move.

However, I have a dual-sensor rate-response with a minute ventilation sensor and an accelerometer, and that's something you should have got, too. Unfortunately, Medtronic doesn't produce any pacers with both sensors anymore. The minute ventilation helps to keep the rate appropriate when exercising for a longer period of time. The accelerometer doesn't do that. At least that's what I have been told, and I have once tried with accelerometer only and didn't do well. All of the EPs I know say young and active people need two sensors for rate response. Of course, only when they suffer from chronotopic incompetence.

Has your cardio tried to set the "level of activity" to "very high"? That way it won't pace you up the max heart rate with every little movement. "Very high" means you are very well trained, and a well trained body doesn't need such a fast rate response. Then there is another RR setting, at least in my pacer, that can be "learning", "automatic" or "fixed". I had mine changed to "fixed" and this has also helped with the high heart rates in daily life.

Best wishes
Inga

Dual Sensor

by greg.bikes - 2010-05-19 02:05:04

I'm a highly competitive cyclist and runner and as luck would have it, one of my training partners works for Boston Scientific. After hearing that my Dr was going to install a single-sensor model (different maker) he brought out the equipment he uses to tune the dual-sensor PM and ran it in a demo mode showing me all the settings he can make to tune and shape the RR. In addition to being an elite athlete he is also has a masters in exercise physiology. He convinced me that the combination of accelerometer and minute ventilation sensors is the only way to go for athletes. I'm now going to use a different cardio to make the implant so I can use this PM. I also learned that leads are standardized so a Boston Scientific PM can be plugged into Medtronic leads. My advice is to find a Cardio that deals with the dual-sensor and make plans for a replacement when it's time for a change-out.

Error

by gailie - 2010-05-19 05:05:37

Thank you for all your comments. I had thought mine was a dual sensor, but thought it was a Medtronic as this was the patient manual given me. That was just given for general information apparently! On checking, I actually have a ELA, with PAS leads. So the accelerometer and minute ventialtion can be adjusted. We are currently experimenting, as the technicians are not sure how to fine tune. They are great in they say just keep coming back till we get it right, although seems a bit of a waste of their time. Is it different for every individual athlete, or is it just trial and error?
Thanks

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