Atrial Sensing & ventricular 100% pacing plus Rate Response turned on

Rate Response…. on or off ?

by IAN MC - 2018-07-28 05:34:42

Hello    If you feel better with RR switched on then you need it , if you don't feel better then have it switched off  would be my simple answer.   But life is never that simple.

The ONLY determining factor regarding Rate Response is whether or not you suffer from "Chronotropic Incompetence "    and this is basically a failure to  have the required increase in heart-rate when you exercise .   There seem to be many causes of C.I. .. The ageing process is way up there, (dammit ) as can be the effects of some drugs e.g. beta blockers and very commonly some sort of sinus node dysfunction. I notice you say " surely if the top part of my heart is working OK.. "        How do you know it is ?

Also very importantly  , it is not just a case of having RR switched on or off . The settings have to be optimised for each individual .

- Do you need it to kick in after a small amount of exercise or only after vigorous exercise  

- At what rate should the RR increase your HR when you are exercising ? 

- What  maximum HR should the Rate response sensor allow you to reach when you exercise ? 

- How quickly should it allow your HR to return to normal ?

These settings are best determined in an exercise stress test where you are all wired up while you walk/run on a treadmill..  I see  that you, too, are in the UK . I have had several of these treadmill tests done on the NHS and at various times have had RR swiched on, switched off and have had various adjustments to the settings.

It is of course possible that you don't need Rate Response at all but it is really great if you do need it and the settings are optimised. Equally it feels bad if you have it switched on but the settings are wrong for you.

Best of luck

Ian

Atrial Sensing & ventricular 100% pacing plus Rate Response turned on

by 3degree - 2018-07-28 13:31:55

Hi Ian Thanks for the interesting iformation in your comment. The Technician on his report says AP% 3.70 RVP% 99.90. In ASVP (CHB with no ULR @ 30 ppm) - amongst other things plus he made the following Programme changes:

PVAB to partial +: no more FFW reproduced.USR to140 ppm. Base rate to 50ppm. RAAVD On. RR on (even though good spread in HR histograms - explore further benefits with this feature).4/12F/U to assess FFRW and patient's symptoms.

Maybe this helps to show why RR was turned on?

Maybe, as a group, we can decode this...

by AgentX86 - 2018-07-29 00:31:16

AP% 3.70 RVP% 99.90: This is pretty clear.  You're atrial paced 3.7% of the time (your SI node starts 96.7% of the heartbeats - and sensed by your pacemaker).  Your pacemaker transmits 99.9% (in other words, all) of the atrial activity (whether initiated by the SI node or pacemaker) to the ventricles.  That is, you have a complete heart block and your sinus node isn't great, either.

CHB with no ULR @ 30 ppm: Complete Heart Block, which we gathered from the above and no "ULR" @30BPM.  I don't know what "ULR" means but by the context, I'd guess that you have no escape rhythm, at least as tested down to 30bpm (they're not allowed to test for lower escape rhythms).

PAVB= Post Atrial Ventricular Blanking period (the time the atrial sense lead is blind after the ventricle fires.  What "partial" means, I have no idea. 

no more FFW reproduced:  No clue what this means

USR to140 ppm: My guess is that your upper sinus rate is set to 140BPM.  That is, the maximum heart rate.

Base rate to 50ppm:  Pretty clear - Minimum heart rate is 50bpm.

RAAVD ON: Rate adaptive Atrial Ventrical Delay is "on"

RR on (even though good spread in HR histograms: Rate Response is turned on (even though it appears your SI node is functional) <= this does seem counterintuitive.

explore further benefits...:  We're going to play with your settings some more next time.  Translated:  We don't know what we're doing but we'll experiment further on this suck, err, patient.  ;-)

I don't see why rate response is on, just that it is.

????

by IAN MC - 2018-07-29 03:38:34

Trying to decipher that lot is way above my pay grade but I would imagine at best the data would give probabilities of you needing Rate Response. I hope there is someone with expert knowledge out there who can enlighten us.

The fundamental question is how does a Dr diagnose whether you are chronotropically incompetent or not  ( i.e. how does your heart respond to the demands of exercise  ? )

I know that chemical stress tests can be used but I would have thought that ideally exercise should feature in the diagnostic tests.

I have always got the impression that in the real world RR is usually tried on a  " suck it and see " basis. If it helps you, you need it . If it doesn't you don't .......but I may be wrong !

Ian

rate response

by Tracey_E - 2018-07-29 08:28:43

Short answer, most with heart block don't need rate response. Some doctors turn it off. Some leave it on to see if we need it. You are using it 3.7% so you are using it. My numbers are similar. I pace 100% ventricle, 2-3% atrial. I don't need rate response often but I like having it on because it's helpful at the gym. I've had it both on and off and can definitely tell a difference in my workouts.

It's not a big deal to try it both ways. You might feel better with it off. You might feel better with the sensitivity adjusted. They can tweak how often it kicks in without turning it off. No two of us are alike so sometimes settings are a bit of trial and error. A treadmill is a great way to figure out what's going on and tinker with the settings. Adjust, run, watch what happens, adjust again, run again. I've done that more than once, it saves trips back. 

Atrial Sensing & ventricular 100% pacing plus Rate Response

by 3degree - 2018-07-30 02:53:52

Thanks everyone for your comments and help. As usual very good responses and reassuring helpful answers X Thanks again X Alan