Worried

Hi Everyone,
I am fairly new here and have been learning a lot. I had a dual lead pacemaker implanted a week ago. I have been feeling great since the surgery and was up and about walking. I did not realize how badly I felt until I started feeling good with the PM.

I have been walking since day 2 post op and my pacemaker has gone up to 125 BPM and I have not felt any pre-PM symptoms. Today I challenged myself and went spinning, everything was going great then at 130 BPM I blocked I got all those nasty incompetence symptoms bringing my HR down to 67. Stayed there until I caught my breath. Am now worried could my leads have dislodged? At discharge, I asked the cardiologist what the settings were on my pacemaker and he said that there is no upper limit set. Then I asked if I worked out hard and could my HR go to 170? and he said yes. Then continued to say that if I find that I am struggling during my workouts, I could have the rate response turned on. I really don't know what to think. It has only been a week and I don't remember feeling this good, awake, alert for so many years. I am a 43 year old female and want to keep up an active style.

I have followed all the discharge directions to a T. I am walking (up to 10k) because there were no restrictions to walking and the same with spinning, that was not restricted.

Thoughts and advice gladly welcomed.

3 Comments

settings/review with Dr

by techiej - 2016-05-28 05:05:36

The upper limit on the PM is the highest rate that it will pace you at - not the highest rate that your heart can achieve on its own.

Rate response is very important if you are active - depending upon the PM it can be based upon movement and/or respiration. Basically, it allows the PM to speed up your HR based upon exertion.

I am not nearly as active as you but have had to have my response rate increased twice since the PM was put in as my heart was not picking up speed fast enough to support my exertion. The downside is that if it responds too fast you will feel like your heart is racing when you're not doing anything.

The response rate is easy for the Dr/nurse/tech to adjust as it is all external and you should talk to them about adjusting it - normally it is done during the follow-up appointments. I would suggest you write down the dates & times when you were exerting yourself but were "out of it" so that they can check the PM & your heart during those periods as the PM will records some of this info.

Max HR

by BillH - 2016-05-28 07:05:20

Actually there is a max HR for the PM.

But there are a number of variables because of the number of different operating modes and value settings.

For example, if the atria is being monitored and the ventricle is being paced. Then there is a settable, upper limit, called the maximum tracking rate.

If the atria is being monitor and paced and if the heart HR does not naturally increase my it-self then rate response is used. And that has a different max setting, long which several other setting that control how much and how fast it increase the HR.

And there are several setting that control the timing between an atria pulse beat (either natural or PM) and the time for ventricle pulse from the PM.

A miss setting on that, or the max tracking rate and the PM can go into a 2:1 block where only half the pulse are sent to the ventricle.

Also you might have had some form of arrhythmia that can cause these problems.

In any case call the doctors office Tuesday and see if the want to see you or maybe download if you have a remote monitor.

maximum pacing HR

by peter.harridge - 2016-07-31 20:24:55

I have had a pacemaker fitted this year. I am a cyclist competing in time trials in the UK. Until this week the maximum the pacemaker paced was set at 130, but I still had problems in the time trial, the feeling is that I am going irregular when the HR is over 130, so they moved it up to 160. But we know I had a HR of 167 while cycling because they told me that last week. Is there any reason why we can't go higher, 160 certainly helped me this weekend where I was a lot better after the race, normally can't even walk when back at the HQ. But clearly I went over 160 as was stll a little bit shaky. Needed a chair quick!  and a GTN spray. So the question is, would there be any good reason why I can't go higher still and have the pacemaker setting go to 170. I am 60.

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