Rate Response

response

by mewsician - 2021-05-18 13:23:59

I would call and ask that an interrogation be done today. Sending a transmission will not work unless you were exercising within 10 feet from  your monitor.

Recent thread related to your question

by Persephone - 2021-05-18 14:18:53

Hi Ms Rutledge - this recent thread may be helpful if you haven't yet seen it:

https://pacemakerclub.com/message/40940/bpm-question

I would seek advice from your consultant or pacemaker clinic

by Gemita - 2021-05-18 15:08:31

Ms Rutledge,

Looking at your history, I see that you have been having difficulties and I quote for the benefit of members what your consultant found :-

"There have been numerous episodes of mode switching noted. It appears that these are actually due to intermittent far-field R wave over-sensing rather than true atrial fibrillation.  Of note, it appears on interrogation today that the patient is in complete heart block with ventricular escape ~45 bpm,    patient is intermittently mode switching due to far-field R wave over-sensing and ventricular rate is abruptly changing to back-up VVI rate. I have lengthened PVAB today in an attempt to blank inappropriate sensing on atrial lead. Additionally, I have lengthened AV delays slightly in an attempt to provide more filling time.. Should we ultimately be unsuccessful with reprogramming, we will consider atrial lead revision".

In view of the above I would go back to your clinic for advice.  Only they can really tell you what this incident may signify.

You specifically asked “did my pacemaker pick up something after the high heart rate of 153 bpm so it would not kick in”?  I would suggest this is quite possible depending on what has been set up in your pacemaker and only your doctors will know this.  We can only speculate what might have happened.   For example if you experienced an arrhythmia at a high heart rate, this could well have triggered a mode switch to prevent the fast atrial rates from being transmitted to your ventricles.  As a sufferer of mode switches (plenty of them) I can state that I am very symptomatic during switches.  I would also suggest that whatever rhythm disturbance was picked up, either caused by the pacemaker reprogramming/current settings or by an irregular heart rhythm for example, could well have triggered your symptoms, which is why I would recommend going back to your doctors for guidance.

How are you feeling generally?  And can you describe your symptoms during the difficulty you had today?  Have you tried to send a transmission to your doctors?  If anything significant was seen, it should be picked up.

I do hope for the very best for you.  I also attach a good definition of Rate Response in case this helps?

https://www.pacemakerclub.com/message/35693/rate-response

Rate Response

by Ms Rutledge - 2021-05-18 15:37:31

Gemita, Thank you for responding, to be honest my pacemaker has been a pain in my neck from the third day after they implanted it.  I am sure you have read in past comments that in the beginning  I was told, my symptoms were not heart related. So I have been trying to get the settings changed for some time.  This is from my last in  interrogation,

Previous reprogramming including lengthened PVAB and lengthened AV delays have been successful in preventing inappropriate mode switching but has not made a significant impact on her symptom complex. Although her rate response curve appears to be a normal, Bell shaped curve, my suspicion now turns to the possibility that she may be experiencing primary chronotropic incompetence given low percent of pacing >90 bpm and reported high activity level. As such, I will turn "on" the patient's sensor and will plan to see this patient back in clinic in 2-3 months to assess the effect of programming changes. I have suggested that the patient follow with Dr. Michael Gold given his experience with troubleshooting pacing. Should we ultimately be less than successful with reprogramming, we will consider atrial lead revision.

I feel pretty well,  a great improvement  in excerising. Of course after a slow jog of 60 to 75 seconds, and a heart rate  of approx.   135-140 I am short of breath, but quickly recover. Before I could only jog 30 to 45 seconds before short of breath and a heart rate of 100-105.

   This may not be the smartest decision, but I think I will try my normal routine tomorrow, and if I have the same issues I will call the Dr. office.   Just on a side note the doctor that has really listened and made the changes has left the office(just my luck) , that is why I am seeing someone new. 

Yes, collect the evidence tomorrow, if you can

by Gemita - 2021-05-18 15:44:03

Do you have a heart monitor (or smart watch) so that you can record what actually happens when you push your heart rate up, or when it perhaps suddenly drops?  You could test this tomorrow and send a reading to your doctors for analysis?  If you feel well, I will back you in attempting more of the same tomorrow (are we foolish?!).  How you feel tells me a lot, so I am less concerned now.

It sounds as though your doctors are still trying to understand what is really going on which is very frustrating and worrying for you.  The primary Chronotropic Incompetence diagnosis still appears somewhat “provisional" to me.   You definitely need continuity and a good EP moving forward. Let us hope they can get to the bottom of your problems and give you a firm diagnosis and way forward.

Rate Response

by Ms Rutledge - 2021-05-18 16:33:17

 mewsician  

Thank you I have the Medtronic Carelink App on my phone, it was with me so I will be able to send a transmission.   After some thought I am going to excerise as normal tomorrow and if I experience the same issue I will call the office and send a transmission.  It just really stinks as during excerise for the last 3 weeks I have not had one issue.  Thanks again for your suggestion.  

Rate Response

by Ms Rutledge - 2021-05-18 17:12:28

Gemita,  Thanks again for you reply.   I have an Apple watch with the EKG app on it, I was not sure if they were very helpful, for people with pacemakers.   

The EP that has been so great,  (so sad he is leaving as he really took time and listened  ) I recall him stating during our first visit he really did not think  chronotropic incompetence was the issue, that  is why he did not turn "my sensor " on.    I think I have left him scratching his head a couple of times. He  has referred me to the top EP, so I should be in good hands.   It is just a little discouraging  as my mother and mother in law both had pacemakers and they put them in and that was it, and I have been trying for  almost two years to get the settings correct for me.   Thank you again you are very helpful and informative.