Rate réponse optimization

I am trying to determine if rate response optimization should be on or off for my pacemaker. I have an Advisa DR MRI Sure scan pacemaker model A2DR01 which was installed in January 2014. I am a 62 year old woman who is very healthy and exercise regularly but had bradycardia and my HR was as low as 27 and regularly in the 30's before my pacemaker was put in. My current range is 55-165 and ADL is 115. I am paced virtually 100% of the time. We have continued to move both the slope of the lines and my ADL and max rate up to accommodate my physical activity because I am in good health and I needed more from my pacemaker when I was exercising. I am noticing now that my HR does not get as high as it did when it was first put in and was told about rate response optimization which I'm wondering if it is limiting my HR. I have been very frustrated with my ability to bike ride and understand the accelerometer limits my ability to get a higher HR on a bike but am also suspicious that rate response optimization may be an influencing factor.
I have also recently experienced light headedness when I'm doing barre. I have worn my HR monitor and am usually below 100 even when working hard. If we turn rate response optimization off, how do you know how to manually set it?

3 Comments

I'd have to go with Ian MC

by Theknotguy - 2015-12-13 01:12:48

I've got the Medtronic Advisa too but I think my RR is still on. Difference being, they've got me on afib drugs that won't allow my HR to get above 120BPM unless there's a problem. Consequently I'm not doing the faster exercise you and Ian are doing. Mine is slower exercise for longer periods of time.

While the accelerometer is working fine for me I have run into a couple of occasions where it's caused weird results. One being the use of a reciprocating saw - the vibration went up my arm and kicked off my PM. It musta thought I was running or something.

I'd also have to go with Ian's comment about the PM working within the parameters within which it is set to operate. During cardio rehab I was walking into situations on the treadmill where the response wasn't what I needed as the accelerometer wasn't being activated. I had to learn how to slowly increase my speed so the PM would keep up with the changes.

Question in my mind now is after two years has the PM made adjustments or have I just unconsciously learned how to work with it. The number of times I'm dizzy and out of breath are almost nil, and even then, only happen under extreme conditions. So is it the normal body reaction or has the PM adjusted?

I think Ian has hit the nail on the head about optimization too.

Another question in my mind is what if you went into a gym, used a treadmill, and watched what happens? Maybe that would give you some insight into when and where you get SOB and dizzy. Knowing that you could work with your PM tech and see if they could tweak the settings? When I was using the treadmill I'd be watching the numbers and mentally record how I felt. Got so that at the end of cardio rehab I could run the numbers up to full speed without getting SOB and dizzy. Maybe it isn't what you want, but it would give you some idea of what is causing problems.

Hope something I've said here helps. You're going into the snow season so it's a good time to switch to indoor work.

Rate Response

by BillH - 2015-12-13 04:12:42

Try and get a hold of manufactures tech that is familiar with working with athletes or active people. You might try contacting Medtronics to see if they have one in your area.

Then have then work with you to adjust it after you make trail exercises. Use your bike, a treadmill, or even running stairs.


Try it switched off

by IAN MC - 2015-12-13 09:12:08

I also have the Medtronic Advisa and had RR Optimisation switched off originally then had it switched on.

I must say it seemed to work for me and the Rate Response function seemed to smooth out and improve with time. The more exercise history it has, the more useful the Optimisation feature becomes. I find it encouraging that the little box is automatically tailoring the RR to meet my lifestyle. But its effectiveness does depend on the parameters within which it is set to operate.

I suspect that the accelerometer is your main problem but :-

Why not have the Optimisation switched off and see how the Rate Response works without it . You may then of course need more visits to your PM guru for manual adjustments.

Ian

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