New pacer. Exercise issues

 I am a 67 y/o recent recipient of a Medtronic Azure XT DR pacer for heart block and chronotropic incompetence. I am very active preferring cycling as my exercise of choice. I have struggled with random fast heart rates occurring with minimal exertion walking. Upper limit HR 130 seems to gradually upslope when cycling but once I hit it the rate tends to hold despite easier exertion at crest of a hill. Also noticed that bumpy downhills (gravel rides) keep HR elevated as well. Still working with my device manager. Would be interested in the pdf Frankmcw mentioned in previous posts Thank you for any recommendations or input you may have. 
WK

2 Comments

Sounds as though you also have an element of exercise-induced tachycardia

by crustyg - 2020-08-17 17:53:33

It would be worth making sure that you know where the 'random fast heart rates' are coming from.  If atrial, then a well adjusted PM with atrial pacing might keep them under control, if ventricular then you're heading into tiger country.

You've noticed that bumpy riding increases your HR, and that's to be expected if the accelerometer of your PM is set to max sensitivity (driving the rate response algorithm). You can't get away from this if you want a decent HR when cycling uphill with your PM.

Have a chat with your EP doc at your next follow up, and make sure that you cover these points.  Established AFib might not matter to you depending on the degree of your HB, but episodes of VTach, *or* episodes of Atrial-tachy with only 2:1 HB might be a real problem.

New Pacer. Exercise issues

by WK - 2020-08-20 20:51:00

Thank you Crustyg. Since decreasing the ADL sensitivity my tachycardia with minimal exertion has resolved. I am still perplexed as to why my HR remains at 130 (maximum ventricular pacing limit) long after I crest a steep hill and then gliding for a significant amount of time. Today this occurred on road bike on smooth pavement. It eventually comes down but I do not need 130 going down a hill!  I wonder about the deceleration adjustment. I think it is set at 10 minutes. What is it and what is the "exercise" setting. 
Thank you for any input. 

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