Rate Response Settings are?

Hello,

I have a Medtronic Azure S DR MRI dual-lead pacemaker.

Rate Response was recently turned on, and I understand in general how it works.  Movement triggers it, it will likely have to be tweaked some more, etc.

What I'm trying to get an understanding of is - can these things below each be adjusted individually (by my EP of course)?  And if so, by how much?

  1. Sensitivity - how much movement it takes to trigger rate/pacing up?  Settings are L, M, H?
  2. Can how fast it ramps up once triggered be adjusted?  E.g. a really quick jump higher, ori t slowly raises your rate? 
  3. Can how long it takes to ramp back down after it no longer senses motion be adjusted?
  4. Can what types of motions do or do not trigger RR increases be set?
  5. Can it be time of day controlled?  E.g. there are no (or at least less) RR increases during a defined time when you are asleep.  I.e. rolling over in one’s sleep doesn’t trigger it.
  6. Other parameters?

Thanks for any clarity anyone can give!

3 Comments

Rate response - your PM increases the paced HR according to software settings

by crustyg - 2024-08-05 18:00:35

1 Sensitivity: by how much does your device increase HR for any given amount of movement

2 [Edited] Many devices probably do use *rate* of acceleration (as well as the amount of acceleration) detected by the sensor to adjust the rate of change of HR, and I suspect that the sensitivity control changes this responsiveness as well as the amount of HR increase for any given movement.

3 Most devices have a setting that controls over what period of time your HR drops back to the lowest value if RR doesn't provide any input.  Suddenly dropping your HR from maxHR to lowest level over 15s wouldn't be good for most patients.  And similarly keeping you at maxHR for 30min after 2 burpee squats wouldn't be good either.  What any given patient needs is somewhere between those two.

4 Depends on how many accelerometers your device has, and how they are monitored.  The leadless devices usually have 3 and can be calibrated so that they are *effectively* mounted in the 3 obvious axes - horizontal, vertical and sideways for a standing patient.  Boston Sci Accolade has one, mounted so that it only responds to forward/backward movement.  Others may differ.

5 Time of day - not usually.  What happens if you fly from London to Tokyo and now your device won't give you a raised HR as you wander around Japan (or Aus, NZ etc,)?  Some devices have a lower minimum HR for nighttime, but it's not without issues.  If you tell your EP-team that you're moving several time zones for several months they can adjust the timezone of your device.  Devices don't usually follow daylight-saving adjustments - it's just too complicated with no international agreement on when these adjustments are made.

6 Many devices have additional settings to control RR, which is why this group has frequent contributions from folk with SS+CI who need their device tuning for their lifestyle.  I'm told that the dancers want very rapid increase in HR as quickly as possible, to avoid dropping BP as big muscles start to demand more oxygen (so the arteries open up and lower BP).  Other people want to avoid over-pacing (can raise BP and increase risk of stroke).

Try and get hold of the Reference manual for your device, read it and ask questions - perhaps here - about the bits that you'd like more understanding of.  Rate Response is a modest attempt to replicate the body's natural ability to increase/decrease HR in response to the body's needs.  It's still far from perfect, but it works well enough for a lot of people.

Re: Sensitivity

by KBos34 - 2024-08-05 19:32:02

My sensitivity adjustments were/are challenging. When it is set too low, I don't get enough assistance when appropriate. When it is set too high, I get too much assistance - for example when driving down an interstate in need of repair my HR has been known to jump to 130. Your lifestyle, needs, meds and diagnosis will all figure into your adjustments. Good luck!

lifestyle?

by Rosie P - 2024-09-15 19:57:49

I have the same device and am trying to be patient as my settings get adjusted to my lifestyle. May I ask what your RR is set at? I am an active person and need to find out what mine is set at.  I have this constant feeling of lighheadedness and wonder if this might be contributing. 

 

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I, too, am feeling tons better since my implant.