Paced settings

Recent app with new Cardiiologist resulted in lead change and several follow up visits to readjust settings on rate response which has allowed me to run better, I'm in DDDR again upper rate to 170 exertion response from 3 to 5 activity threshold from med/low to low but my question is in trying to help my anaerobic feeling while running he moved paced AV to 180 ms, sensed AV to 180 max increase to AV 100ms,,,does this make sense or is the the reason I now don't have the breathless feeling from before but feel breathing is Ok but only shallow, to get a full heavy or deep oxygen filled breath I have to force a heavy breath every 20 to 30 secs. It feels like maybe my heart is not getting a full diastolic filling.
I had originally suggested again shutting off rate response he felt that would make me feel worse. I was afraid to try that and now still wonder but I'm somewhat better but don't want to go backwards although this Dr is much more receptive to discussion and wanting to find the right settings,,,,thanks gang !!!

4 Comments

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by golden_snitch - 2014-06-06 03:06:39

Hi!

First of all, from the info provided I don't fully understand what your cardio did with regards to the delays. Usually, when it comes to exercising, the AV-delay needs to shorten. Let me give you an example from my pacemaker, it automatically shortens the AV-delay the higher the heart rate gets: At 60bpm the paced AV is 150ms, at 80bpm it's 140ms, at 100bpm it's 130, ..., at 140bpm it is 120ms. Given those settings, it seems to me that your 180ms paced AV is probably too long. But then, I have no idea for what rate this is the setting. Could be that it's the setting for the base rate.

Your pacemaker should have a similar automatic AV-delay feature:
http://www.medtronicfeatures.com/browse-features/all/CDF_DF_RATE-ADAPTIVE-AV#drawer_0

The paced AV-delay is relevant after paced atrial event. It's the interval between a paced atrial event, and a paced ventricular event. The sensed AV-delay is relevant when you are not paced in the atria. It's the interval between a sensed atrial impulse, and a paced ventricular impulse. So, for heart block patients it's important.

I read in one of your other postings that you are 98% atrially paced. So, the paced AV-delay should be of importance to you. Since you have a healthy AV-node, it's all about giving it enough time to do the job; the pacemaker should not need to pace your ventricle. Not sure that changing this setting makes any difference for you. Only situation in which it might make a difference is, if it's set too short and the pacemaker stimulates your ventricle too early, not giving the atria enough time to fully contract.

I guess your tricky settings are the rate response settings. By changing the exertion response from 3 to 5, the rate responsiveness is increased, it's more aggressive. Same goes for lowering the sensor threshold. So, with these settings changes your heart rate should increase faster, even with minimal exertion.
See: http://www.medtronicfeatures.com/browse-features/all/CDF_DF_RATE-RESPONSE#drawer_0

Hope this helps.

Inga

rate response

by Stillrunning - 2014-06-10 11:06:09

If they shut off the rate response will the AV delay still be in effect,,,
I wonder if I could get to a setting that only the lower rates for Bradycardia are all that's activated,,,
Reason being I was fine running and daily activity to use a pacer term,, I had a blockage had to go to ER for this everybody went in a panic at my low HR of 30's which I have had a HR under 40 for yrs ,,always stronn low BP , excellent good cholesterol 90 tp 100 and then I get a stint and PM and exercise problems ever since,,,

AV-delay

by golden_snitch - 2014-06-16 03:06:25

Yes, of course it will still be in effect. The AV-delay is not a special RR parameter, but one that you need for every dual-chamber device. If you want the rate response off, let them do two treadmill tests: one with it switched on, and one with it switched off. Then you'll know whether you need it or not. Could very well be that you suffered from bradycardia at rest only, but that your own rhythm was keeping up well when you exercised.

And once that's been done, maybe you should give the fine tuning a break, and give your device/the rate response time to adjust automatically. Your rate response can do that.

Inga

AV-delay

by Stillrunning - 2014-06-18 12:06:01

Ok thanks, the rate response seems to be Ok the first wk then it seems to get worse and worse, my best experience is always the first few days then worse and worse that's what I struggle to understand. I have called the Medtronic support but they really only want to very general support nothing technical, I have called 3 times and basically get work with your dr. I can't comment on specifics.

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