Remodel?

Happy Thanksgiving!!!

So I had the Medtronic Adapta installed on 11/9/12 for AV Block (exercised induced) that I have been dealing with for a few years. My HR would not go above 80 no matter what my activity was.

Since implant; a lot of other symptoms have corrected such as yard work, speed walking, etc... much better with lots more energy and no symptoms anymore!

Now, I have recently started to jog again - nice and slow as I am basically starting all over again. I feel great, but when I get to 1/4 to 1/2 mile - I start to get my old symptoms again... fullness in the stomach, chest heaviness, then weakness in the legs. Although it is not nearly as bad or intense as before implant, and at times I can jog through it; could it be a remodeling issue as my ventricles aren't used to going as fast now?

I mentioned it to the DR so he did an interrogation - everything is still functioning as it should. He said to give it time as it has only been a little over a week (two weeks tomorrow)...

Anyone else experience this?

19 Comments

Exercising above Upper Tracking LImit

by ElectricFrank - 2012-11-23 01:11:20

This is not a good thing no matter what story the doc tells. When you exceed the upper limit the HR can suddenly drop or become erratic. This happens at a time when cardiac demand is high. The reduced output can't be good for your heart or the rest of your body.

Most of the docs are not runners and have no idea what it feels like in or out of shape.

The only answer is to be insistent about increasing the limit.

I've also found it helpful to request a written statement justifying the docs diagnosis. They find they can tell verbal stories to patients but get uneasy when it is in writing for other docs to see.

frank

My Rate Response is off....

by USMC-Pacer - 2012-11-23 01:11:47

So would there be any other settings I could ask the DR about? It almost seems to me that the pacer isn't pacing the way it should. For me, it is simple HB with a healthy sinus, so I thought it would pace with the sinus beat for beat... for whatever reason, it doesn't appear to be doing that.. again, they interrogated it and all is "fine." Just give yourself more time... so that is where I am at til the 12th of Dec for my 1 month pacer clinic checkup...

Tracking rate

by golden_snitch - 2012-11-23 02:11:00

Hi!

It is tracking the sinus node rate, but if your upper rate (tracking) limit is defined to be 150bpm and you have a heart block, it will stop tracking at 150bpm. So, no matter how fast your sinus node gets, the ventricular pacer lead won't follow it, but will stop at 150bpm and probably even go into 2:1 Wenckebach block. Understand the problem? A healthy AV-node would just keep conducting the impulses coming from the sinus node, but with a pacemaker taking over the AV-node's function you have kind of a "filter" built in. And this filter goes into 2:1 block at much lower rates than a healthy AV-node would, depending on what is programmed.

You need a higher upper tracking rate. Keep insisting on that, and tell the doctor about your wish to continue running and your many years of experience as a runner.

Good luck!
Inga

Now I see..

by USMC-Pacer - 2012-11-23 02:11:37

I guess it is possible that I am hitting the upper 150# as the reason I am getting my symptoms again. Especially if it drops me into a 2:1 block which was my diagnosis prior to implant. So, I will certainly be on them to raise that...a few questions if you don't mind:

How high can it go / what should I ask for?

Is hitting that limit while exercising dangerous? Other than the crappy feeling it causes, can it be harmful? Or, is it just a nuisance?

Thank you for the help Snitch and everyone!

Upper rate limit

by golden_snitch - 2012-11-23 04:11:29

Hi!

I started running about two months ago. Although my pacer's rate response was set to increase my heart rate rather slowly, I often ended up reaching my upper rate limit - at that time 150 bpm -, and then went into 2:1 block, so the rate dropped to 75bpm all of a sudden. No fun at all.
I had the upper limit changed to 175bpm, and the level of activity from "high" to "very high" which means that the pacer thinks I'm very well trained and therefore do not need a fast rate response. The result is that I'm no longer reaching the upper rate limit, so no more going into 2:1 block, and I run at 150-160 bpm most of the time, sometimes a bit less. Doing much better now!

Keep insisting on a higher upper rate limit. There is no need to limit it to 150bpm, if you "only" have a rhythm issue (that only makes sense in heart failure patients or patients who recently had a heart surgery or heart attack).

Best wishes
Inga

Ran again today and...

by USMC-Pacer - 2012-11-23 05:11:04

I monitored my HR every time I felt the symptom, sure enough I am at / close to the 150# / so when I go back to the DR, I will encourage him to set it higher... Although, I am getting further and further before it is occurring so perhaps my fitness is improving.

Yet another question: Can the pacer clinic make this adjustment?

Thanks again for helping me track this down!

Hi

by Moner - 2012-11-23 05:11:07

Hi USMC - Pacer,

If I recall didn't your originally have it set at 130 bpm, then it went to 150 bpm.

I think you're being very polite when you say "encourage" the doctor to set it higher than 150 bpm.

You should insist, and if there is some resistance, as Frank stated, get it in writing.

We both have the same type of pacemaker and mine was originally set at the factory setting of 130 bpm.

Mine is now set at 185bpm, to avoid the Wenckbach block settings that Snitch was describing.

Good luck with your next visit.

Moner
>^..^<

Also noteworthy..

by USMC-Pacer - 2012-11-23 05:11:21

If you attempt to check your HR after the symptoms have started, it is tough. As Inga / Snitch has said, your HR goes all erratic (that's for sure) so, I was checking mine at the very first hint of it...Just an FYI for anyone else experiencing this...

Thanks Moner

by USMC-Pacer - 2012-11-23 06:11:06

Yes it was originally at 120 (default) but before I even left the hospital, the DR put it at 150 where it is now. You're right and I will insist that he raise it... Can the pacer clinic do this, or does it have to be my EP?

Thanks again@

Hi Mz.A

by USMC-Pacer - 2012-11-23 12:11:22

Yeah, I am pretty much the same. I haven't gotten 2 miles (as far as jogging) yet or to the vomiting part, but the on and off symptom of it I have. I mean that it comes and goes fast. I can't quite understand what is causing it because it comes on so fast, not like a gradual running out of breath like a conditioning thing would do. I have been a runner for years, I know full well what it feels like to be out of condition, this is different and much more sudden.

I will certainly keep you updated if they correct something in my settings... So far, my EP / Techs have been easy to get along with. Hopefully, they will put me on the treadmill and figure this out.

Yeah!

by Moner - 2012-11-24 04:11:09

Hi USMC,

I'm happy you are going to ask for a higher rate setting, I've learned so much from members like Electric Frank, Snitch and Tracey E, each time I go for my appointments, I always feel like I'm well armed , knowing I get sound advice from these people.

Keep on jogging.

Moner
>^..^<

Politics...

by USMC-Pacer - 2012-11-24 04:11:44

I figured as much.. I will call my EP before my appointment so maybe he can contact to authorize the change. That way everyone will be happy....especially me!

I am very thankful...

by USMC-Pacer - 2012-11-24 05:11:38

for this site and for all the help I have received! Without it, I would have probably gave up and became a couch potato...

I can't wait so I may call my EP on Monday and see if he can just bump it up then.. only takes him what; a minute?

Depends on politics

by ElectricFrank - 2012-11-24 12:11:50

Technically the clinic can program the higher settings, but often medical politics get in the way.

As for exercising above the limit it isn't advisable. Look at it this way. If your car engine started missing on half its cylinders when you exceeded 60mph, would you drive it at 70? (If the answer is yes I can't help you)

frank

Funny Frank!

by USMC-Pacer - 2012-11-25 01:11:31

I am actually looking forward to it! :-)

Ouch Potato

by ElectricFrank - 2012-11-25 01:11:58

Bump up the limit, exercise harder, and become an ouch potato.

frank

Good news...

by USMC-Pacer - 2012-11-26 06:11:01

I got an appointment for tomorrow after work to have my upper rate raised from 150 to ???.. I spoke to a physician's Assistant and she said it would be quick and no problem. Hopefully they push it out to at least 175+, that way I won't be hitting it often during exercise if at all... That must be close to my max anyway. I don't understand why they don't do this in the first place if I am not in a category that needs to be restricted??? Anyway, I am happy that they are going to take care of it!

Thanks again for everyone's help!

PS, I will report back on the results; rate and how it feels..

One More Thing

by Moner - 2012-11-27 02:11:57

Hi again,

I've copied and pasted this information that came directly from the Medtronic Manual with respect the the Upper Tracking Rate, it's pretty much what Electric Frank summed up:

Upper Tracking Rate
The programmable Upper Tracking Rate is the maximum rate at which the ventricle may be paced in response to sensed atrial events when the pacemaker is operating in the DDDR, DDD, and VDD modes. Sensed atrial events below the Upper Tracking Ratewill be tracked at a 1:1 ratio, but sensed events above the UpperTracking Rate will result in pacemaker Wenckebach (for example,6:5, 4:3, 3:2, or 2:1 block).
I found this on page 60 of their manual.

We both have the same model, if you need the web-address let me know.

Saw the DR. today..

by USMC-Pacer - 2012-11-27 10:11:10

I was raised from 150 to 175, yeh!!! I haven't had the chance to take it for a test ride yet.. but will tomorrow after work and report back. I am thinking that there has got to be a significant difference between 150 and 175 in exercise tolerance...

You know you're wired when...

You read consumer reports before upgrading to a new model.

Member Quotes

The pacer systems are really very reliable. The main problem is the incompetent programming of them. If yours is working well for you, get on with life and enjoy it. You probably are more at risk of problems with a valve job than the pacer.