Pace maker

Is 60 BPM too high?

by Gotrhythm - 2017-11-04 16:49:54

Too high for what?

For most people the only question is how you feel and whether you can participate in the activities that you want to. The setting that allows the best quality of life is the right setting. If down the road you feel that 60 BPM isn't right for you, it can be changed. But unless something is bothering you right now, why worry about it?

Glad you seem to be doing so well but being able to run hard at 5/6 weeks is putting the bar pretty high. By all means have your goals, but respect the fact that your heart needs time to adjust to being paced. Healing is taking place on the inside even after the incision appears closed. 

Listen to your body and make haste slowly. Running hard again will happen sooner if you don't force it.

Is 60 BMP Too high

by Fencer - 2017-11-04 16:58:58

Hi Gotrythm,

thanks for your comments and reassurance.

Give it some time .....

by MartyP - 2017-11-04 18:12:43

I also had mine se at 60 when I got Sparky this past may.  About 3 weeks out I went back to the Cardiologist and EP and they said it was pacing to much at 60 so they lowered it to 55.

At 55, it only paces at night when I'm sleeping.

So you can wait till November 30th or ask if you can move up your appointment.

Once they look at the history they will know if they can lower it.  Maybe 55 or I think the lowest might be 50.  You and the doc Just want to make sure you don't faint or feel weak.

So you will be fine - just ask when you see them.

probably fine

by Tracey_E - 2017-11-04 21:32:26

How do you feel when you run? If you feel good, then give the current settings a chance.

Your resting rate is probably artificially low due to the block. Lower limit is usually the atrial lead, which we rarely use with av block. Our sinus node is setting the pace, all the pacer is doing is making the ventricles beat when the atria does.It gives the  heart a fraction of a second to stay in sync, for the ventricles to beat after the atria beats. If it does not, it kicks in and paces a beat. It's playing follow the leader and completing the broken circuit, not setting the pace.

Give it a shot and see how you feel. If it's really bugging you, they can turn it down. But you may find that you feel good and have more energy. You may not feel a difference. They may turn it down and your rate stays the same. My resting rate jumped to 80's when I was first paced. It eventually settled down to a more normal rate, but that's how fast my atria was going on its own after so many years of being out of sync.

Upper limit is what's important to us. The pacer can only pace the ventricles up to the upper limit. Ask what it is. If it's low, and it may be because 120-130 is a normal starting point, then it will only pace you up to that so if your sinus rate gets to 150, you'll be out of sync again. That's the number one thing athletic patients with av block need adjusted. You want your upper limit to be about 10 bpm above where you normally stay on exertion. 

Heart rate,

by Fencer - 2017-11-05 09:52:09

thanks to traceyE and Marty for your very valuable information. The real test will come when I start to do the hard yards(miles) and whether I will cope. My maximum heart rate before the spark plug change was 153.

Heart rate

by SUPERMAC - 2017-11-05 17:55:46

Hi Fencer,

I also had a PM fitted (5th January 2017) due to low resting pulse, low 30's but down to 16 at night, and I also have a block. I also do quite a lot of sport including 5 marathons. Mine was set at 50, but with a top limit of 130. I struggled with the running for some months before they agreed to lift the top limit to 155. My running is now much easier and I am not continually out of breath when I run. I've had no issues with the lower setting.

Take your time before asking for adjustments, but very best of luck Let me know how you get on.

Heart rate

by JacekU - 2017-11-12 07:57:28

I  was under impression that we shouldn't be paced unnecessary as to retain natural heart operating rytm as long as possible.  My lower setting is at 50. Before pacemaker my fitbit was showing my resting rate of approximately 45. I  have asked to lower my settings to 45 but was dissuaded as my pacemaker works only 1.5 percent of time and that is during the night time.

Fine tuning the programming rates

by Hoosier Daddy - 2017-11-22 22:24:20

My device is for resynch therapy, not for bradycardia, so I'm not sure what preoperative assessment your EP would have performed with you. Did they assess your baseline resting and active heart rates? I must imagine that they did, but I'm not familiar with what an EP would typically bother with in the British health service. 

A thorough preop workup would guage your asymptomatic resting rate, the rate at which you become symptomatic, your chronotropic competence (ability to vary, in particular, your ability to GO FAST with physical activity), and your empirical peak heart rate. 

By the way, there are tables of normal values, but especially as an athlete, YOUR rates should have been determined empirically.

There IS a downside to having your resting rate programmed "too high" -- decreased battery life. I could go into the esoteric subjects of increased risk of CAUSING atrial fibrillation from having one's RV driven by a pacemaker, and the theoretical problem of INTRAventricular dyssynchrony from the RV being activated by a lead in the RV apex (a healthy heart naturally starts the electricity in the septum and finishes at the apex). But these risks are hypothetical and are greatly outweighed by a device which keeps your cardiac output adequate by preventing excessive bradycardia.

NOT TO WORRY -- it is better to be paced above a rate at which your cardiac output is so low that you're symptomatic than to not be paced.

But just as your medications' doses are tailored to your response, your device's programmed rates should be customized for you. So you can receive the benefit of avoiding the symptoms of a heart rate of 30 yet minimize the side effects of gratuitous RV apical pacing.

"One size fits all" is certainly not the case with our CIEDs.

Good luck with your EP visit next week.