SSS AND EXERCISE

Rate Response is tricky to get right

by Gemita - 2023-02-24 12:55:18

Laurie, hello.  I thought I would just quickly respond to give you my experience with Rate Response.  Initially I had this turned on and it was way too sensitive for me and I felt my heart racing out of control and yet when I tried to go up steps, I was still fighting for breath, so not a good experience.  They then turned it off and my racing heart settled.  

I also have Sick Sinus Syndrome and have difficulty in getting my heart rate to increase;  it seems very static at times.  My EP mentioned I had “flat” histograms, which perhaps suggests I never move which just isn’t the case.  They did try turning on Rate Response again recently, and it didn’t seem to make any difference to my ability to increase my heart rate, although we didn't persevere with Rate Response since it worsened my arrhythmias (Atrial Fibrillation and other atrial tachy arrhythmias), so they switched it back off!

I would ask your EP whether Rate Response is likely to be the problem and whether it needs adjusting or whether there are other causes for your symptoms of a racing heart, perhaps other settings need looking at too?  

Your heart should have settled down by now, although I recall my heart needed 3-4 months of healing after pacemaker implant before my tachy arrhythmias settled and my heart got used to pacing.  Also Laurie, Rate Response can take quite a long time to get it adjusted to suit, so you will need to be patient.  Some members work with their technicians to get their settings finely adjusted.  You could ask for some exercise (treadmill) testing to find the right settings for you?  

exercise

by laurieb03 - 2023-02-24 13:40:18

thanks gemita- that is very helpful!!

The Need for Speed

by Gotrhythm - 2023-02-24 15:10:49

I'm a little puzzled. Feeling the heart "racing" and a heartrate of 88 don't match. 88 isn't a particularly fast heartrate. Are you able to  take your pulse at the exact time you feel the racing, or is there a time lapse?

Gemita's comments are always excellant, but just to offer a slight clarification. Rate Response (RR) can be turned on or off but turning it off is not the only option if you're not comfortable with it.

A pacemaker's RR feature has several levels that determine how gradually or rapidly acceleration will happen, in response to your body movement. The levels also control how long it takes to go back to the resting rate once you stop exercising. My new pacemaker (St.Jude) is currently at level 4--one level below the fastest response. Finding the level that's right for you makes a big difference in how you feel during exercise.

That said, I'm wondering if the problem has anything to do with your pacemaker or RR at all, since you said the symptoms also occur when you take a hot shower. Heat (or hot weather) does not have any effect upon RR. The RR is responding to vibrations caused by moving your body.

However heat will definitely affect your heart. Remember, even though you have SSS, you heart is still able to beat without it. It just isn't fast enough most of the time to let you function well. But anytime your heart can accelerate on it's on, the pacemaker will let it. This racing heart might be something your heart is doing on it's own.

It's good you have an appointment with the EP. Hopefully you'll soon get a handle on what's going on.

SSS and Exercise

by AgentX86 - 2023-02-24 16:08:01

As the others pointed out rate reponse may or may not be needed with SSS.  You could easily have tachy/Brady, as well.  This is where the heart is too slow (Bradycardia), until it's too fast (tachycardia). The pacemaker can take care of the Brady part but the tachy part needs can only be dealt with with drugs.  The drugs slow the heart, which can mean more Brady, which your pacemaker corrects (got that? 😁).

RR is a two-edged sword.  Set it to activate too soon and you may feel like your heart is racing.  Too slow and you huff and puff until it catches up.  Top end too low, you have a governor on your engine.  Too high and you may have tachycardia issues.  Somehow you have to find a balance in there.  Except for the high end, the other settings are really your call.  Whatever makes you feel better.

I have my rate response set to as fast as it'll climb with a slow-down a fair bit slower. My assumption is that if I'm exerting energy then stopping that I'll soon pick it up again. It works for me so that's what I have. Stairs are still a big problem and always will be.

RR in Boston Sc. Accolade

by Rch - 2023-02-26 21:22:25

I do not have chronotropic incompetence nor I'm pm- dependent ( yet!). But my Device tech has turned on the Accelerometer and my RR is on! I am about 7 months out with the implant. I find that whenever I move my left arm briskly such as applying soap in the shower, swinging my left arm briskly while sitting or slowly walking etc shoots up my HR to over a 100+ from the basal rate of 60. These palpitations feel a bit uncomfortable compared to that of elevated HR while I'm on the treadmill. I believe the brisk left arm movements in the sedantary position are RR  paced atrial and sensed V beats, while the elevated HR on the treadmill is most likely the intrinsic sympathetic response to exercise ( intrinsic atrial beats, not paced)! I'm just guessing!

I have an appointment with the device tech on 03/1/2023 and I'm going ask her to switch off the accelerometer to passive and see if it helps!