RATE RESPONSE

Hello ... I had a PM fitted 4 weeks ago because of sick sinus syndrome and am having my first checkup tomorrow. the lower limit is set at 50bpm. I don't know if an upper limit is set, or not.
I am an exercise fanatic and am a keen runner,as well as playing regular tennis and golf. So far everything feels great and I'm going off to play tennis in 10 minutes time .
I understand that rate response can be either switched on or off. I will find out tomorrow which mine is.Could someone explain why it should ever be switched off. Is it not ALWAYS beneficial to have your heart rate respond to exercise ??
thanks Ian

8 Comments

rate response

by Tracey_E - 2011-09-29 07:09:13

With SSS, rr will be on and that's just how you want it! SSS means the sinus node gets lazy and your hr does not go up as it should. When the pm senses you are active, rr will raise your rate for you.

RR is not needed for those of us with av block. With av block the sinus node works normally and will go up as it should with exercise but the signal gets blocked on the way to the ventricles. In this case, rr is not necessary and can sometimes compete with our own natural rate so we may feel better with it turned off. Av block generally paces ventricle while sss generally paces atrial. We all get the same two lead pm but they work differently depending on why you have it.

Rate Response

by SMITTY - 2011-09-29 09:09:29

Hello Ian,

While waiting for tomorrow to get here there is a little home test you can give yourself to find out if the rate response on your pacemaker is turned on.

After resting for a few minutes count your pulse. Then find a place on your chest 3 or 4 inches from your PM implant site and tap on your chest for 30 to 30 seconds. The tapping does not have to be bone rattling, but does need to be hard enough to jar your PM a little. After the tapping check your pulse. If your rate response is on your heart rate should have increased. How much increase you see, if any, will depend on your PM settings. Now I can't guarantee this is an accurate test, but it never fails to work for me.

Also, let your Dr tell you if you do, or do not need the rate response turned on. I have SSS, among other things, and when I got my PM in 2000 I didn't need it turned on. With exercise my heart rate would go up all by itself. As the years have gone by my heart has needed more and more help from my PM and today the RR is both good and bad. It will increase my heart rate when it is needed, but it will also increase my heart rate with such little activity as walking at a normal pace for 50'. During my next checkup I'll be asking if the sensitivity of the RR can be turned down.

As usual, everything comes with a price attached.

Good luck,

Smitty

Rate Response

by IAN MC - 2011-09-29 10:09:13

Hello Smitty
Thanks for your advice. I have just tried the "finger tapping test" and my HR went up from 61 to 67. I'm not sur if the PM kicked in to cause the increase or whether it was my heart responding to the exercise. I will find out tomorrow. Your comments re RR not necessarily being good were very intersting.
Thanks Ian

Rate Response

by SMITTY - 2011-09-29 12:09:49

Ian,

My guess is your RR is not on. Based on what mine does, I would have expected your heart rate to go up to the high 80s or low 90s for a minute or two. Of course yours could still be on and the RR settings require more than a gentle nudging to wake it up. Hope you can let us know what the Dr tells you.

Smitty

Rate response

by ElectricFrank - 2011-09-30 01:09:07

I'll try to put it simply and another way.

Yes, you always want your HR to respond to exercise.

Best is for it to respond naturally, and is why RR is best left off.

If it doesn't respond naturally due to some heart electrical problem then RR is the next best thing.

In my case RR is off. When relaxing my HR is down in the 58-60 bmp range. When climbing a steep trail it ranges up into the 135-140bpm range. By the way I'm 81 yrs. I have the upper limit set to 150 to keep in out of the way.

frank

Rate Response

by ranchp - 2011-09-30 05:09:18

Hi Ian,

I am keen to monitor your progress as I have a similar situation. I suffer CI my base HR is 51bpm but recently my PM reported prolonged ectopic betas Now I;m on beta blockers. This aggravates my CI, I am a fitness pursuant. I can hardly get my HR beyond 110. Comments welcome.

ranch

Rate Response

by IAN MC - 2011-09-30 10:09:57

Everbody's comments have been so helpful . Having just had my first check-up :-

- Smitty you were right, my RR is turned off, it seems that I don't need it. As Frank said " it is best for the heart to respond naturally to exercise"

-Ranch, I don't have the knowledge to comment on your condition...if your HR won't go above 110 do we assume that your rate response is turned off.? If this is the case you may benefit from it, but you need to get expert advice.

Upper limits

by ElectricFrank - 2011-10-01 12:10:01

There are a couple more settings that can affect your hearts response to exercise.

There is one called something like Upper Ventricular Tracking Rate, which sets the maximum rate under which the ventricles will track the atrial beats. This one presents some insidious issues for those of us that are active. The problem is that the only way the pacer can keep the ventricle pacing below the limit is to cause it to skip beats. So HR will increase nicely with exercise until it reaches the limit, and then start running like an engine with bad spark plugs. To make matters worse this happens at a point where oxygen demand requires a higher HR. After my implant my upper rate was set at 125 based on my age. I couldn't even walk against a high desert wind without hitting the limit. After a bit of a bruha with the cardio mine was set to 150 and I monitor my HR myself and keep it in range.

The other upper limit has to do with the way Rate Response handles exercise and is a bit complex. It only is important if RR is on. For active persons it really needs to be set by the manufacturers rep while you are exercising on a treadmill.

Hope this helps,
frank

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