Heart rate and excercise

Some thoughts and questions

by Gemita - 2020-08-25 13:00:33

Hello Savannah,

Firstly your cardiologist was very harsh to suggest you need more exercise to correct your breathlessness and fatigue, especially since you clearly have Atrial Tachycardia (AT) which he will well know can cause breathlessness.  Even short runs of AT at high rates can cause breathlessness for me and I am extremely fit for a 71 year old.  There is just no way I can push through an AT episode without getting symptoms.  

As far as your clinic saying that no arrhythmia was detected during the period you mentioned, it would depend on what has been set up in your pacemaker.  If say an arrhythmia could only be recorded if it occurred at a certain speed, for a certain duration, and your episodes did not match the capture algorithms set up by your EP/cardiologist, then clearly what you felt and confirmed yourself, would not have been recorded by your pacemaker.   I would want to know the following:

At what rate/speed (bpm) will my pacemaker start to automatically record and store an AT event ?

At what duration (the minimum beats required) will my pacemaker start to automatically record and store an AT event ?  The more you know about what has been set up, the better Savannah.

Secondly looking at your post, it seems to me as though there may be a problem with your pacemaker’s rate response settings/sensitivity.  I am no expert here, but hopefully others will have some technical advice to offer based on your post.  In case of help, my Medtronic rate response settings are:

Basic rate 70 bpm

Upper tracking rate 130 bpm

Upper sensor rate 130 bpm

AV delay (sensed) in (ms) 150

AV delay (paced) in (ms) 180

Rate Adaptive Yes

Mode switch is turned on to prevent tracking atrial tachy arrhythmias when they occur

Mode is AAI<=>DDD

By the way, did they turn on MVP = managed ventricular pacing?  I recall in one of your posts you mentioned they were going to turn this either on or off ?

I would go back to them and ask what your settings are and ask them if these need to be adjusted to help with your symptoms.  Bisoprolol will help to calm AT but it may make it more difficult for you to get your heart rate up and to keep it up.  This is what happens to me.  I would also push to be seen as soon as possible for your EP study/ablation, explaining quite frankly the sooner you can fix your AT the sooner you can ever hope to exercise to your full potential.  And please ask them to treat you with more respect.

120 to 60

by Tracey_E - 2020-08-25 21:42:47

No amount of fitness is going to allow you to feel good if your rate is tanking from 120 to 60! I hate when they jump to stupid conclusions. Yes, they probably see a lot of patients who are not fit but it's dangerous to assume that. Even an Olympic athlete would feel like they'd hit a wall if that happened.

Push for a stress test, that will show them real time what is happening. My rate would tank sometimes while working out so the pacer was programmed to watch for the drops and kick in with pacing to keep it level. It can come down slowly but no more sudden drops. We figured this out on the treadmill in the office. 

Another possibility, tho with only being 120 it's less likely, is the safety feature that looks out for afib, then it cuts our rate in half and puts us in an artificial 2:1 block. If we are in afib this is great, if we are working out not so much. I had this happen but it was at 150, so considerably higher than 120. If that's what it is and you have no history of afib, they can turn it off. This would have shown up in the report if they'd been looking in the right place so my money is on problem #1. 

Settings

by Savannah55 - 2020-09-07 04:48:20

I have had a routine pacing check and finally got a printout of my settings;

Lower rate 60bpm

Upper tracking 150bpm

Upper sense 130bpm

Paced AV 180ms

Sensed AV 180ms

Rate response OFF (as sinus node is fine apparently)

PVARP 300ms plus loads of other refractory/blanking settings to accompany this. 

NCAP 300ms 

There were quite a few AT episodes recorded so between the pacemaker settings and beta blockers they aren't really working! Just got to wait it out for my EP study.

Sudden drop in HR

by Mike417 - 2020-09-13 17:04:25

I started having a similar issue; my HR while exercising will drop from 12-135 to 60 bpm while exercising.  I would feel wiped out, like someone took all the energy out of me.  The PM lab could detect no anomalies.  I started carrying my wrist BP monitor (calibrated against the clinic).  I found that at each episode my BP would drop to less than 100/10.  Now it is a question of which comes first.  Try taking your BP when this occurs, and send the data to your doc.  IReducing my bp meds has helped.  I suspect that I have vasovagal syndrome.

Mike