Heart rate variability?

One Possible Explanation

by IAN MC - 2022-08-20 11:34:52

I see from your Bio. that you are a keen exerciser which is probably why you have an Apple watch.

You will therefore know that exercise is the main driver for heart rate variability ...... the more you exercise, the more oxygen your body needs and the higher your HR goes !

That is fine as long as your heart responds to exercise as it should. If it doesn't your pacemaker has a function called Rate Response which may need switching on and the setting optimising .

It may be a really easy fix so contact your pacemaker clinic. I see that you have a Biotronik pacemaker which happens to have a very  sophisticated rate response function ,known as the " CLS function "

Best of luck and enjoy the spring in your step when you get it back.

Ian

"contact your pacemaker clinic"

by Persephone - 2022-08-20 13:15:03

Hi theresab72 - to second Ian's reply to your concerns, I would say to schedule a setting "tweak" with your clinic, including having a Biotronik rep present. I patiently waited for quite a while after receiving my life-saving PM to raise my hand and ask if it could be better. The benefits of my setting adjustment session were on a similar order of magnitude as getting the PM in the first place. Don't wait as long as I did, would be my recommendation. Best wishes to you.

Biotronik rep

by theresab72 - 2022-08-20 14:09:42

How would I go about having a biotronik rep see me? My EP does not use Biotronik pm's as most of his patients are elderly, and he admittedly doesn't know much about them. He did have rate response turned on, and it backfired, as every time I stood up and walked a few feet, my hr would go up to 120 and I'd get palpitations. So he was advised that I didn't need it and turned it off. Thanks for the advice. 

U.S.A. Health System ??

by IAN MC - 2022-08-20 14:28:00

The actual rate at which your HR increases is one of the variables which can be altered if you have someone knowledgeable doing the settings.

I am not in the U.S. and i  haven't a clue how you would  get a Biotronik rep your side of the pond.

I'm sure some of your fellow citizens will have the answer.

Best of luck

Ian

"My EP does not use Biotronik pm's"

by Persephone - 2022-08-20 14:53:05

I can only say that you need to find an EP who does. I'm not sure how you ended up in your situation, but if I were being treated by a medical practice that said "we're not familiar with the functions of this device we're treating you for", I'd look for another. Maybe I'm misunderstanding.

Find a new Doc

by Good Dog - 2022-08-20 15:37:43

I am sure that you are aware that half of the EP's out there did not finish in the top 50% of their class.

You need to find an EP that is intimately familiar with your PM. It seems that it is not the EP that you have now. I would suggest that you contact Biotronik and ask for a list (not one or two, but many) of doctors that have implanted and/or do implant the most Biotronik PM's in the area in which you live. I don't think that asking for a recommendation is a great idea, because they may not want to offend your current EP by referring you away from him. However, I could be wrong. I am just not sure. Additionally, you could also request your EP or another EP to have a Biotronik Rep assist them in optimizing the rate response settings. It is a very important matter!

In any case, I think that if you call Biotronik, you will likely get the best solution to this problem as expeditiously as is possible. 

I wish you the best!

Sincerely,

Dave

low HRV

by ourswimmer - 2022-08-20 16:28:17

I also am an athlete (guess what sport!) and I got a Biotronik device at the end of March. I use an Oura ring, not an Apple Watch, for tracking.

I think the answer to your first question (does the pacemaker reduce HRV?) is yes. I think that if you had high HRV because of extreme bradycardia, your HRV will decline if you have a device in there to force a beat when your lazy sinoatrial node would rather not.

(theresab72 knows this, but for the others who answered: HRV isn't how fast your HR rises to meet stress. It's the beat-to-beat variation in your HR, and for unpaced people it's a fitness measure, for which higher generally is better.)

I think the answer to your second question (is low HRV why I still feel so sluggish?) is no. I do agree with the suggestions to find an EP who actually uses and knows your device and to investigate whether different settings would help you. In particular, turning OFF CLS rate response seems to me to be a mysterious choice. Sure, having your heart race when you get up for a drink of water is not good, but you want more beats when you really need them.

My personal anecdote: My resting HR had been very low for years. In the few years before I got the device, the overnight HR got even lower and my HRV was VERY HIGH (200+, usually). In fact, during the months before I finally realized I had a cardiology problem rather than a motivation problem, my ring started having big overnight data gaps that I now realize were because its algorithm couldn't understand my very slow and irregular overnight HR. But it kept reporting to me that I was very fit by its metrics because my HR was low and my HRV was high.

Now my overnight HRV is around 50 and my overnight HR never goes below 40 (my minimum) and the ring thinks I need to rest. Meanwhile, however, I feel great. I actually am sleeping a lot better than I did when my heart was going so slow overnight.

My EP chose a Biotronik device for me specifically because she thought it would work best for my sport, and the CLS rate response does work very well for me. I haven't tested it in a sprint race (where a very fast rise from low to max would be necessary) and I probably never will, but it pushes my HR up enough for workouts to be fun again.

I certainly hope you can get a solution for this problem. Best wishes.
 

50% of their class.

by AgentX86 - 2022-08-20 22:50:40

This really isn't true.  Electrophysiology is a sub-specialty of cardiology.  This specialization is done during residency then fellowship programs, with EPs going on further than cardiologists.  They've already graduate at the top of their class or wouldn't have gotten that far. If they didn't know what they were doing they would have washed out long  before being board certified.

It's really not all that surprising that an EP wouldn't know all of the settings of all pacemakers.  Indeed, the device salesman will probably advise the EP which PM to use. It's unusual for an EP to use more than one manufacturer's devices.

  The EP should set the guidelines for pacing (max/min rates, etc.) and it's up the device tech to get it tuned in.  There has to be a Biotronic trained tech available.  If they get stumped, they may call in a factory rep but you're no likely to get one directly.

An EP might agree to set up a stress-like test where the PM tech can tune your pacemaker under direction of the EP.

50% of their class

by Good Dog - 2022-08-21 09:16:27

The 50% response that I gave is not really the point here. The point is:

She said that her EP advised her that she did not need rate response and turned it off. That clearly was not a solution to her problem and there is no indication that any attempt was made to find one. If the folks responding in this forum can recognize and understand that she has an unresolved problem that negatively impacts the quality of her life, why doesn't her EP? I certainly would not continue to see that same doc. That is the point. 

HRV

by MinimeJer05 - 2022-08-22 14:24:48

Hello,

It sounds like you are getting good direction from other members -- but I would like to chime in as a fellow Apple Watch user to say that the data isn't always accurate either. My HRV has been very low for the past few years, and I've mostly felt fine working out and actually went on a solid 5 months of intense cardio workouts and it didn't seem to raise the number at all.

If I look at my data on a weekly basis, it also randomly shoots up and then drops really low (as in, low numbers around 26 and high numbers around 75).

To make matters more interesting, I have compared data to my wife and a few friends (they all have Apple Watches and they all vary in terms of physical exercise and general fitness) and everyone across the board had numbers as low as mine -- which I find hard to believe. 

I'm not saying the data is wrong, but I am also not saying that it is right. Sometimes, I get too fixated on my Apple Watch numbers and forget to stop and think about HOW I FEEL or IS THERE A PATTERN.

It sounds like you have been feeling sluggish and not right, which is why everyone has chimed in with advice and suggestions -- but for someone that otherwise feels normal (or sometimes even great), I'd say to just be aware of the number and to bring it up, but not to worry unless there were other reasons to indicate worry.

Take care

Jer

Get good pacemaker technical support

by Gotrhythm - 2022-08-24 12:18:05

Rate Response does not have to be either on or off. There are many intermediate settings that can be tailored to support your individual exercise requirements. With the riight setttings, you can and should be able to enjoy whatever you can do at your fitness level.

You can live without rate response. BUT If you need rate response but you don't have the level you need, you will never feel your best.

Pacemakers are marvels of engineering, but like all computers they can only do what they are programmed to do. That means you must seek the best technical support you can find to have the quality of life you deserve.

Travel if you must to get to a good person. go to a major medical center. Once you get it right you'll only need to go back once a year.

"I don't know much about Biotronik" is an honest ansere, but it isn't an acceptible one.

Educate yourself. Advocate for yourself. A good, really good quality of life is possible!