RR and sensitivity.

I took my first cycle class yesterday (3.5 weeks out).
I have worked out for the last couple weeks with elliptical, steppers etc and have felt to PM "kick in' and then sustain my heart rate@120 to 140.

I took a cycle class , took it fairly easy. Kept my heart rate under 140 ( I am 54 year old female). Then the HRM went to zero then stayed @ 70 for several minutes. I did back way off and just waited to see if the PM would take over. I feel like it did not. I hovered around 80 the slowly went back up to 120. Out of fear and frustration I cooled down and left the class.
( I use to teach this class!)

Today I just felt off. Lightheaded, fuzzy. I have an apt tomorrow to have the PM read and check leads.
I have read the different in RR and sensitivity and several comments about Medtronic not responding well for cyclist.

I need to ask the right questions tomorrow. I have had one adjustment at 2 weeks out. But yesterday's episode @ gym and several nights of heart pounding @2 am earned an appointment tomorrow morning.

Could if be that staying seated during a cycle class( instead forward motion as on other equipment) did not trigger the PM??

I feel I need to be a major participant in getting the adjustments that I require.

What should I ask, suggestions welcomed!

9 Comments

cycling

by Tracey_E - 2014-12-30 08:12:08

If your pacer is relying on movement to kick in with rate response, and that is how Medtronic works, it isn't going to work well in a cycle class because your torso doesn't move.

Don't go by the hrm on the machines, they are notoriously inaccurate with us. Go by how you feel. If you feel bad, stop and count manually.

Ask if you are set to self-check at 2am. That could be the pounding you felt.

You were right to stop the class when you didn't feel well. Any time your rate isn't high enough and you are lightheaded, back off. Document what happened and what time so they can check it on the report. It can take some time to get the settings adjusted properly, this is normal. There are quite a few settings they can tinker with and they like to do small increments, try it out, then adjust again if necessary. If it gets too drawn out, ask to get on a treadmill while on the pm computer so they can watch what is happening. However, if the root of the problem is your pm only senses movement before kicking in, any exercise that doesn't have much torso movement is going to be a problem and there isn't much they can do. Good luck!!

"self-check?"

by dlruddick - 2014-12-30 08:12:25

Ok, just do not know enough about this pacemaker yet. What is "set to self -check?"

Also , I wear a Polar Heart rate monitor with a chest strap to monitor my work outs, so I try not to over do.

So , my EP said you will be able to do everything you did before the PM... I am a cycle instructor for the local YMCA. This is one time I do not want to prove him wrong. I am hoping there is a way to get this PM to get along with me and my lifestyle!

I have a call into a Medtronic rep. His sister is a close friend and he is an athlete. I hope he can shed some light .

Thanks for you response.

Rate response

by golden_snitch - 2014-12-31 04:12:59

Hi!

Don't you have an intermittent heart block only? If so, you do not need the rate response sensor. Your sinus node is functioning perfectly fine, the rate response is only needed, if the sinus node is sick and unable to set the pace. What is of interest and can cause problems during heart block episodes is the so called "upper tracking rate". It's the heart rate until which the ventricular pacemaker lead tracks what your sinus node is doing. If the upper tracking rate is set at 140, and your sinus node does 160, then your ventricles will only be paced at 140. What can also happen, depending on your model and programming, is that the pacemaker goes into a 2:1 block when the upper rate is reached or exceeded (sinus node going faster). When that happens, your heart rate drops for instance from 140 to 70. To solve this problem you simply program the upper tracking rate higher. Most pacemakers allow programming up to 180, the Medtronic Adapta even up to 220.

Most of today's pacemakers can do an automatic threshold test ("automatic capture management"), and it's often programmed to happen at nighttime; mine is set at 2:30 a.m. It's a test to check how much energy is needed to stimulate the heart effectively, and then the output voltage (amplitude) is adjusted accordingly. Checking the threshold regularly can help to save battery life. But if it bothers you too much, you can either have it switched off or set at a different time, during the day for instance.

Inga

Upper tracking rate

by golden_snitch - 2014-12-31 07:12:28

The upper tracking rate is no specific rate response setting, but one that is programmed even if the rate response is switched off. And it's important for heart block patients, because it's the rate at which the pacemaker will stop tracking the sinus node.

Good luck with your appointment!

Inga

Still learning

by dlruddick - 2014-12-31 07:12:42

Hello Inga,
I have a Medtronic Advisa DR MRI Surescan pacemaker. I vaguely remember to Doc stating that he set the limits from 40 to 180 ( not sure Versed is powerful).

I also vaguely remember being told the SA nodes were good. I was so sick after anesthesia that I can not remember the entire conversation. I have not seen the Doc yet, just a nurse at the wound check appointment who stated that she "shortened " the response time

" 2:1 block when the upper rate is reached or exceeded (sinus node going faster). When that happens, your heart rate drops for instance from 140 to 70." Sounds exactly like what happened during the cycle class.
Someone is checking my device @ 10 am today. I doubt I see the doctor unless they find something of concern.

I guess I really need to ask :
1) The Sinus nodes are good?
2) is the rate response on and why?
3) If #2 is yes what are the limits?

I greatly appreciate what you have responded. I have learned far more from this site than the medical team!

another comment

by RDD - 2014-12-31 08:12:14

golden_snitch knows far more about the subtleties of PM operation and physiology (I'm ashamed to say since I'm a retired Dr.) but I DO know that IF your HR is dependent on the PM alone, the Medtronic will never accomplish what you desire as per TraceyE's comments. You might want to reference my comments to "Energy" and her similar complaints...you can find them on-site. Good Luck.

Dennis

Yet another comment

by IAN MC - 2014-12-31 09:12:17

You need to add another question to the 3 that you listed :-

4) What is my upper tracking rate setting and should I have it raised ?

It sounds as though you only have two choices, either to raise the upper tracking limit or make sure that you keep your exercise levels to around 5 bpm below the limit.

Often people get confused about the 2 different upper limits that can be set . One is the upper limit for the Rate Response . This is simply the highest heart rate at which RR will add extra beats when you exercise. It sounds , from your medical history though that you probably don't need RR.

Then there is the upper tracking rate which as Inga says is the maximum when , anything above that, the PM will stop tracking the atrial rate. If this is set too low you can hit a situation where you are exercising at a level where your body wants say 130 bpm , but this happens to be your maximum tracking rate, so your heart suddenly starts beating at 65 bpm and this is possibly what is happening in your cycle class

Let us know the outcome of your appointment

Ian

Heart block while biking

by WillieG - 2014-12-31 11:12:20

I have had similar experiences like you described while biking outdoors or spinning indoors. I had my PM implanted last June for intermittent heart blocks that only occur with exercise when my HR is over 150. After several adjustments, I still experience blocks about once a month. I wear the Polar monitor with a chest strap which seems to be very accurate. My HR will drop in half for about 30 seconds and then return to normal. Or sometimes, it will go up and down from say 152 to 72. Unlike you, I have never felt faint and can continue to pedal uphill during these episodes. At my 1st 3 month remote interrogation, I had tons of atrial oversensing, such as 686,000 PACs and 99 atrial tachy responses with mode switches. I recently wore a Holter monitor and worked hard to create a block for interpretation. The report showed pacemaker mediated tachycardia during the block. My upper rate is set for 175 on my Boston Scientific PM and I may have gotten to 176 to create the block. The next day, they turned off the atrial channel and changed me from DDD to VVI. The Holter report also said my block was Mobitz I and not Mobitz II, which was why they put the PM in during the EP study. So I am frustrated to have a PM that is doing nothing. My average HR during the study was 92 so I doubt it would go below 30, which is the current setting, without me noticing a difference.

I will look forward to seeing how they may change your settings. Good luck and Happy New year!

Update and still fighting!

by dlruddick - 2015-01-15 08:01:40

Interesting enough, I too am wearing an event monitor. I was called by my EP nurse and told that everything looked great on the recordings. Maintaining 80. I assured my nurse that "80"" is not being maintained during the cycle classes and that I dropping form 148 to 80 on at least 3 occasions during every 50-60 min class I have taken.

I used to teach these classes and now I am struggling to keep up!

A Medtronic's rep admitted to me that cyclist are one the hardest groups to get adjusted and that there were 100's of adjustment combos to work with.

Looks like another phone call is on the agenda.

I am still wearing the event monitor but am now frustrated that it is not painting an accurate picture of what is happening.

Tonight I requested another stress test to prove my point.

I DO feel better after my PM placement. I am not grabbing for a ledge when I jump out of bed in the morning. Even though I am having heart rate issues when I work out harder, my color is "red" not "ghost white" as it was before. I definitely have more energy.

However, I am not ready to settle. I will not go away quietly.

You know you're wired when...

Your heart beats like a teenager in love.

Member Quotes

I had a pacemaker when I was 11. I never once thought I wasn't a 'normal kid' nor was I ever treated differently because of it. I could do everything all my friends were doing; I just happened to have a battery attached to my heart to help it work.