Base and upper rate

Changes to Settings

by Penguin - 2023-11-12 05:35:59

Hi, 

Thanks for the post and for highlighting that it's always helpful to tell patients about changes made to our settings.  This happens quite a bit to pacemaker patients and it's annoying. It would have been much easier to tell you what was done at the time and why. Saves unnecessary phone calls too which I imagine impact on busy clinics.

I can only give you my own explanation why you feel as you do: 

1. I find that most changes to programmed heart rates have an effect that takes a little time to get used to.  You may be feeling 'less' atrial pacing particularly if you have been paced at 70 bpm for a long time and if there is a significant decrease in the amount of a.pacing that you receive.  This should improve unless you need a higher atrial rate for something that you or your clinic haven't explained. 

2. The new base rate of 60 bpm means that your heart will be paced when your heart rate falls below 60 bpm. This will probably result in less atrial pacing than you received at 70 bpm.

3. Re: Heart rate rises to 130 bpm -  Your PM has a lower rate - yours is 60 bpm and an upper rate - yours may be 130 bpm.  You can check this on your interrogation papers.  The papers refer to an LRL (lower rate limit) and URL (upper rate limit). 

Your PM will operate between the upper and lower rate. 60-130 bpm is quite a common setting. It will allow your heart to rise to 130 bpm with PM assistance if necessary.  

Once your needs go above 130 bpm you will be dependent on your own heart (without PM assistance).  Depending on your age, medications, diagnosed conditions and fitness levels your heart may or may not be capable of raising it's rate above 130 bpm. 

5. Bisoprolol - This is a beta blocker and (as I understand it) BBs can limit heart rate. 

I hope that makes sense to you. 

Thank you

by mar892ree - 2023-11-12 06:46:55

Thank you for taking time to reply , much appreciated. 

I'm ( apparently) 96% paced ! 

Once again - thank you for taking time to reply - I think I've had more answers/ information from this group than I have the hospital ! I also find it very reassuring too 

96% Paced

by Penguin - 2023-11-12 07:41:40

Hi again, 

I'm assuming that 96% is your atrial pacing %.  This means that your atria (top of the heart / sinus node) are being paced a great deal with your PM set at 70 bpm. 

The next time your clinic interrogate your device the atrial pacing % may be lower.  If this happens it will be because the setting has been changed to 60 bpm.  It isn't a reflection of your Sinus node function. 

Edited: too much info. 

Best Wishes

You need to get your PM settings...

by crustyg - 2023-11-12 13:01:12

...and then you'll be in a position to ask better questions.  Not all EP-teams will give you your settings at the end of each in-person setting: my advice is politely and firmly point out that you will get them anyway by making a Subject Access Request under the Access to Health Records Act 1990.  Unless they are totally wedded (welded?) to a 1950s view of Medicine ("you'll get what I give you and be damn grateful for it") they should back down and accept the USB memory stick that you offer and copy your settings and PM records to it.  Otherwise you'll have a 42day wait (IIRC that's what the legislation requires as a maximum delay on their side).  And it costs them a lot of money for each SAR.  Don't give up or back down.

At least one contributor here has recounted how once she started to show that she understood some of the EP-jargon, her team's view of her changed from 'nice, harmless little old lady' to one of considerable respect and willingness to share key decisions with.  She *is* a lovely, little old lady - harmless, hmm, I wouldn't pick a fight with her!

What the EP-team don't want is to have to spend time explaining the effect of changing pacing mode or lead impedance over time.  But if you ask about exactly what pacing mode you're in and it doesn't end in an R that *may* be the issue.  And there are plenty of folk here who will help you decode the jargon.

FWIW, I had my lower rate dropped from 50BPM to 45BPM - and did my usual Pilates then Yoga classes that evening.  Next morning I was back - by arrangement - to get my lower rate put back to 50BPM.  So we learn.  I can well imagine that a lower rate change from 70BPM to 60BPM has had a bad effect for you.  And being on a beta-blocker won't help.  Several contributors here have found a higher lower-rate limit much better for them.