Medtronic PM's and exercise

Greetings to all....at the suggestion of Inga (aka golden_snitch ... the supreme purveyor of all things related to PM's) I am presenting a dilemma to any of you Medtronic users who might be of help.

I am a 72 y/o man with three aortic valve replacements (1992, 2000, and March 2014) who has remained very athletically active. I had a Medtronic ADDR01, dual-lead, PM installed in January and am currently paced near 100% of the time. With an accelerometer only, the PM is designed to respond to upper body motion only and,in spite of numerous adjustments by my EP, does not respond adequately to my activities (mainly hiking in the mountains and biking). In fact,it actually slows down when hiking up steep hills or biking and will soon reach my baseline of 75 bpm if not interrupted by rapping externally on the PM at a high rate (about 240/minute)...which cannot be done while mountain biking,obviously.

Does anyone have any suggestions for PM settings that might moderate this dilemma....or am I resigned to replacing the Medtronic with another brand that incorporates either a respiratory-rate sensor or CLS ? Thanks.
Dennis

10 Comments

Even though

by Theknotguy - 2014-09-06 04:09:53

Even though the Medtronics has the motion detector I've found it doesn't respond as quickly to exercise. I had to go through heart rehab and learn how my PM would respond to exercise. It just wasn't as fast as my natural heart response. Sorry 'bout that.

But before you start to have a jump up and down, scream and yell session about the Medtronics, I'd find out why they gave you the Medtronics. Each PM has slightly different software attributes and handle different heart problems different ways.

Sometimes the EP doctor has to look at the heart problems you have and match up the PM that will address the heart problems the best. That may mean it doesn't match your life style as well as you'd like but it's a lot better to be alive with a slightly reduced life style than dead with no life style at all.

I also don't know if all PM's will give a reduced response to exercise situations, especially when compared to normal heart responses. So that's something else to factor into your thinking.

Like you, I was extremely active. I went back to doing my charity work but could only work three hours. My cardiologist's response was, "And your point?" Let's see, work three hours or be dead. Hmmm. Guess I'll take the three hours. Since then I've been able to increase my time but it's been a learning curve between problems of recovery, problems with my heart, and learning how to live with the PM.

Hang in there. Being alive is a lot better than being dead!

I had similar problems

by JerryG - 2014-09-07 08:09:29

until my cardio + Medtronic tech got the settings of my A3DR01 dual chamber pacer right for me.

I have sick sinus syndrome hence the pacer. I am 67 and have other problems which prevent me from doing more than brisk walking on my treadmill daily, but I still with incline variations on the treadmill get my HR up to about 75% of my MHR for a 40 minute session.

I also had a problem initially with the Medtronic accelerometer not getting enough upper body movement to respond properly. My last session with my cardio + Medtronic tech was in March and since then I haven't looked back. The tech changed various rate response parameters for my requirement and it worked.

I have a printout of my last settings which I scanned into a .pdf file. You can private message me if you would like a copy of those settings to show your cardio and I will send the file to you.

Bushveld greetings from sunny South Africa

Jerry

Also suggest

by KAG - 2014-09-07 11:09:23

that if they have a treadmill when you get your device tweaked it may help. That way they can adjust and see if it helps or not right away.

Thanks, GoHawks

by RDD - 2014-09-08 01:09:18

Yep, I do the Tarzan bit myself, except that I "tap" on the PM itself at a rate of about 240/min. That will get my heart rate up to 140 (my set max) and suffice to get me up the steep uphills of Idaho. I do have to retap every minute or so to keep my HR up. This, however, isn't practical for me and my 72 y/o balance issues for biking. Question for you....does the problem bother you enough that you would consider a different PM with more than an accelerometer?
Dennis

Keep looking

by GoHawks - 2014-09-08 10:09:45

I totally understand your dilemma. My Medtronic is fantastic when I run. My endurance and speed is as good as it ever was. But, I have the same problem as you when swimming and cycling. I get totally exhausted at both activities. I've learnt to beat my chest - Tarzan like- as I approach a hill when cycling, and that helps to elevate my heart rate up to about 110bpm. Without that extra jump, my rate is about 90 when I'm cycling, not really enough to keep me going as fast as my cycling mates. So, chest beating doesn't seem a really sensible solution, but it's the best I can suggest. Sadly, no retro-fit options for swimming, unless someone else out there has ideas ....

Thanks RDD!

by GoHawks - 2014-09-09 09:09:07

There must be a device we can wear, strapped around our chest like a heart rate monitor that can 'trick' our device to accelerate. Maybe someone can devise that ... Although I reckon it won't come from the Medtronic family.

This is my first device, fitted 9 months ago and my base rate is set at a very modest 40bpm. Tops out at 165bpm. I'm able to live with the accelerometer response for the moment, so I'm not yet inclined to change devices. I'm aware that the model I have now has other advantages. But, I'll be carefully watching for new models with greater adaptability that suit me and I won't hesitate to replace mine early if I can find something gives me better triathlon endurance.

time for Inga??

by RDD - 2014-09-09 10:09:28

GoHawks.....I think it's time for Inga (aka Golden_Snitch) to weigh in on your issue. Sounds like a Boston Scientific with respiratory rate monitor might be the ticket for us both. I intend to wait for a full year after my most recent aortic valve surgery to see what heart/skeletal muscle recovery I get....that will be next March, 2015. Then I will go to either UCSF or Stanford where they have departments that excel in just what we are talking about...which is not really available in most locations...no matter what your cardio/EP tells you.
Dennis

Revised sensitivity settings

by GoHawks - 2014-11-09 02:11:01

I'm not sure if people read old posts, but I've got an update which might interest people on this thread or might be searchable by others. So, I'm just pasting, below, the email I've just sent to my heart specialist following some tinkering with my Medtronic device settings ...

Dear Doctor

I thought I would update you on the effect of changing the sensitivity settings of my device after my last consultation on 31 October. You'll recall that I was especially struggling with my cycling and swimming under the old settings.

I've attached the Garmin heart rate graphs from my last two bike rides: both over the same route (60k +) but on 9 November (post revised settings) and 26 October (old settings).

The difference is significant. I can now cycle without the extreme fatigue and can make it up hills without having to pump the device like Tarzan. It is such a relief and I feel so much better.

The average bpm for my ride is now 139; previously, it was 96bpm.

I've also noticed a positive impact on my swimming and am now able to swim 20 x 50m laps non stop and have achieved a new PB.

There is a down side: I have found that my heart rate does accelerate more quickly when I don't need it for modest mobile activity. So, for example, I am getting a noticeably accelerated heart rate when I'm just walking around the house for a short period.

I need your Medtronic settings

by RDD - 2014-11-10 11:11:17

Hi,GoHawks...
Glad to hear, judging from your letter to your cardiologist, that your PM is now set so that you can bike and swim and get your HR up appropriately. I still can't get mine up above ADL levels with ANY activity other than running. I would love to have a copy of your PM settings to show to my EP and the Medtronic rep. If this is possible, let me know and we can figure out how to do it. Thanks.
Dennis

Medtronics sensitivity

by AbNormative - 2015-01-12 11:01:32

I have a Medtronics pacemaker for chronotropic incompetence (and 2-1 AV node block, bradycardia, escape rhythms). My experience with the sensitivity settings is similar to that of GoHawks and RDD.

We were able to get adequate sensitivity settings for running (but my rate would quickly climb to its maximum and stay there whether I was running hard or taking it easy -- we couldn't get it to be proportionate to how hard I was running.)

Unfortunately my knees deteriorated, so running is out, and my main cardio exercise now is biking. My pacemaker sensitivity was not high enough for biking. We incrementally increased its sensitivity.

And I found, like GoHawks, that it had gotten to the point where my pacemaker would increase my heart rate even when I merely walked. Unlike GoHawks, I felt that that was a serious enough problem that we turned the sensitivity back down one level, without even checking whether it would help my biking or other activities.

So, there we are. Maybe I could learn to walk like a ninja.

-Mark

You know you're wired when...

You get your device tuned-up for hot dates.

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