Heart rate during exercise

rate on exertion

by Tracey_E - 2023-04-03 13:18:49

If your rate isn't going up on its own on exertion, the pacer can be programmed to do it for you. I would go back and ask to be seen, tell them what's happening. 

Rate response

by Julros - 2023-04-03 20:04:02

Many times pacemakers are installed with the basic factory settings. When I first got mine it wouldn't go up when walking, even up inclines. It took a few visits to adjust the rate response, and the doc was willing to increase my upper rate from 130 to 165. Now, a brisk walk gets my rate up to 100, jogging up to 145-150.

Max limit reached?

by John_W - 2023-04-04 03:09:38

Under lighter exercise the rate does increase and feel fine. The hill I walked up yesterday was hard work and I wonder if my pacemaker hit its upper limit of 130bpm and for some reason dropped my heart rate down. I've read somewhere that when upper limit is reached pacemakers skip every second beat. This would make sense as 60bpm is near half of 130 bpm. I've contacted my hospital so await their feedback. Until then I'm going to keep my exercise to lower levels. John.

sort of

by Tracey_E - 2023-04-04 09:59:37

With av block, the pacer is playing follow the leader with the sinus node doing its thing and (presumably) the atria beating normally. It simply watches for the atria to beat and kicks in when the ventricles don't keep up. It will only do this to the upper limit, so if you are set for 130, it can't get you above that no matter how fast the atria is going.

If your sinus rate gets well above the upper limit, the pacer can think you are in afib and that's when it puts us in an artificial 2:1 block and only paces every other beat. When this happens, you'll be going along at your upper limit then suddenly drop in half. Feels a bit like hitting a wall. That doesn't (to my not-a-doctor eye) sound like what is happening here. Hoever, if that is the case, and you have no history of afib, they can simply turn it off. 

If you are bumping the upper limit consistently, and are cleared to exercise that hard, they can turn the upper limit up.

But what I am reading is your rate is simply not going up, 60 at the top of a hill. If that's the case, that's when rate response can be helpful. The pacer senses you are exercising (through motion for most devices) and raises your rate for you. They often don't turn this on to start when pacing for av block, going on the assumption that it's not needed. 

They should be able to tell if any of this is happening with an interrogation. Also, a treadmill can be helpful, walk a hill in the office and they can watch and see what your heart and the pacer are doing. In my case, I was born with av block so until I was paced and active again, no one had any idea I also had sinus issues. The av block masked them because my rate was based solely on what the ventricles did on their own. Once the pacer had the atria and ventricles in sync, a few other problems became clear. All was fixed with the settings, but it took some time and multiple attempts then ultimately the treadmill. 

Be persistent if you need to! 

Tracey_E

by John_W - 2023-04-05 12:03:34

Thanks for your thoughts on this one.

After the valve surgery I did have AFib for a very short period. The pacemaker detected this and I believe it is still set-up to respond to AFib.

Today the Doctor has suggested turning rate response on. I'm not sure this is the answer though because my heart rate increases naturally during everyday activities and moderate exercise and it had done for 52 years before the valve surgery that left me with av block. Today I had an hour of cardio rehab and my heart rate was in the 90-110 bpm range for most of it. I felt fine. The rate dropped to 60 bpm soon after exercising stopped.

I've only had the issue of rate being low during exercise once. This was earlier this week when I had just done my most strenuous exercise since surgery (hot day & long steep hill). I certainly felt it walking up the hill and measured my wrist pulse to find it around 60 bpm. Walking up the hill could easily have pushed my rate above the upper limit of 130 bpm so I think it is an upper limit issue. Next step is going to be asking the hospital to increase my upper limit to 150 bpm and climbing the hill again. Persistence is needed!

rate response

by Tracey_E - 2023-04-08 09:13:11

I would give it a try. If this is a one time thing, it won't do anything. But if you do drop like that again, it'll keep you level. I pace ventricle 100% (av block) but atrial only 1-4% of the time,so not much but it's a nice back up to have when I need it. 

If you are cleared for exercise, 150 upper limit should be an easy sell.