Tuning a Medtronic pacemaker

I am 82 years old and I have had a 3 wire pacemaker implanted several months ago because of a very slow heart rhythm coupled with several rhythm irregularities, including 27% PVCs. I have also been put on a beta blocker, the result of which is that I am now 100% paced. My normal life style has been climbing a 650 foot (15% incline) hill almost daily (from office to home) and cross country skiing 3 days a week during the ski season.

My electrophysiologist did not have a clue how to adjust my pacemaker for these activities and I had to do a small study to figure out appropriate settings. I think I have been reasonably successful in getting my pacemaker adjusted to meet my needs and am now back to my activities. Anybody interested in how I went about it and what my final settings were can find it in my blogger blog, http://lucienp84.blogspot.com/

7 Comments

Well done lucien

by IAN MC - 2014-02-15 08:02:54

I've just read your blog and it is great that you selected a standard exercise regime, in your case a climb to 650 ft, and then measured your times with various PM settings.

You have definitely persuaded me to buy a Polar RCX3 heart rate monitor !

I am interested that you used your under-performance as measured by the Polar recommended heart rates, at various exercise levels, to then have treadmill session.

Am I missing something but if you had done the treadmill test first would that not have identified that you were being under-paced at different exercise levels and that changes in settings were required ?? Or was it simply a case that you needed hard evidence to convince your apparently useless electrophysiologist !

Your story really does highlight how inappropriate the default PM settings are for many of us.

Thanks for your post - very interesting !

Ian

Tuning a Metronic pacemaker

by lucienp84 - 2014-02-15 11:02:02

Without the heart rate monitor I would not have had a sense by how much I get overpaced on a long downhill, or how my heart behaves at 7000 feet while skiing cross country. Nor would I have had a sense of what the pacemaker does on a long climb. Using the pacemaker enabled me to establish benchmarks to simulate on treadmill. I am sure I could not have done this using a treadmill alone. The more information you have, the better off you are. A pacemaker is a very crude device compared to a living heart and all the settings aim at a reasonable compromise. At altitude, I would have been better off with a pacemaker that senses acceleration and breathing rate. But unfortunately, the only one is made by Boston Scientific and it is approved for use in Europe, but not in the US. I will know better by the end of the ski season if it would be worth while (and the considerable cost) to go to Europe to get one implanted. Currently, I could use another 3-5 BPM, which is not all that much and as my conditioning improves that may not be an issue anymore.

Your blog

by jfasoneholder - 2014-02-15 11:02:07

I would love to read your blog but can't find it on the site. Could you direct me please.

Tuning a Metronic pacemaker

by lucienp84 - 2014-02-16 01:02:51

My blog is at http://lucienp84.blogspot.com/

When one goes up to the mountains, one's breathing rate increases to compensate for the reduction in oxygen content in the air. I assume that there has to be a corresponding increase in heart rate, but I do not know how the two are related. My settings seem to be working out ok at 7000 feet, but I have no idea as to what would happen if I went up to 10000 feet. Does anybody know if I would get mountain sickness?


Tuning the pacemaker

by jfasoneholder - 2014-02-16 09:02:13

Thanks for the blog link. Very interesting. I am a 61 year old active woman and I just had my first adjustment done Friday. Much less scientific than the way you did yours and I am going to get the polar HRM you suggest. I have found that there's a lot of art to the science of exercise and not much available knowledge. I hadn't thought about being over paced-- assume that's when your heart rate stays high and you don't need it? That's what was happening to me on the treadmill when I was doing intervals. I'd come off my interval and my heart rate stayed elevated. They brought me from 5 minutes to 2.5 to try to adjust that and increased my max heart rate from 130 to 150. I'm suspicious that my slope might need to be changed to but they only wanted to make those changes first. And I had no idea that if I was spinning I'd have to thump my pm to get it to work. I couldn't figure out why spinning was so hard. You'd think they would tell us these things before it was implanted.
Thanks again for the info!

thumping? and skiing...

by katiemom - 2014-02-17 09:02:15

Hello to all, I'm new to this, to ALL of it. Had my PM implanted on 1/13/14. I am 49 years old. I had a congenital heart defect and worsening arrhythmia over the past 2 years. Like Lucien, I am 100% pacer dependent, and also like him, I cross country ski. I have the accelerometer as well. I do a lot of lower body exercises, spinning, yoga, kickbox. Triathlon has been my sport of choice. Right now we are dealing with arrhythmia that is coming from my AV node, not sure how that is going to be resolved.
However, so far, what the doc has done for my exercise has for the most part, been an epic failure. This accelerometer does not seem to do well with any lower body exercise. I really need suggestions on how people have overcome this. Thumping your PM? How does THAT work? Help, please! Thanks.

Thumping and skiing

by lucienp84 - 2014-02-17 10:02:12

If you have a 3 wire pacemaker, you are out of luck. You will have to abandon some of your sports since no one seems to have a 3 wire dual sensor pacemaker approved by the FDA for use in the US. If you have a 2 wire pacemaker, and can afford to pay for an unscheduled replacement, try to get your pacemaker swapped out for a Boston Scientific Boston Scientific pacemaker that has an accelerometer and minute ventilation. That will enable you to bike, kick box and do the other lower body exercises that do not affect the upper body much.To get a 3 wire, dual sensor pacemaker, you will have to go to Europe where the Boston Scientific Boston Scientific pacemaker is approved. Needless to say, that is bound to be an expensive proposition.

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I have an ICD which is both a pacer/defib. I have no problems with mine and it has saved my life.