From 160 to 60 (II)

Hi everyone from Spain,

Last week (on Thursday), I had an appointment with my Doc and I asked him for a solution. After talking a bit, he changed the settings of my PM. First, he increased my upper limit from 160 to 180. Second, he turn off an option to control tachycardia (I don’t really need this option) so I can go as high as 180 and my PM is not detecting the high rates as a problem.

On Saturday I checked the new settings and I went for a nice mountain tour. As expected, it was much better than before. I went up to 180 without a problem. When I forced a bit more, my PM continued at 180 nearly the whole time, only from time to time it went down to 80 or to 100 for a couple of beats and then up again. I guess it is because my sinus rate was higher than 190-200 and my PM was not able to read all the pulses (?) That’s something that I’m going to ask next week, but I want to try it a bit more before to be sure of what’s going on.

Anyway, I’m able to go as high as 180!!, and only 3 and a half month after the implant !!!

As soon as I have some news I will let you know. Enjoy and take care!

7 Comments

great news!

by Tracey_E - 2008-12-09 07:12:31

That is awesome!!!

There is another setting they can adjust to prevent sudden drops.

How??

by llobet - 2008-12-09 07:12:32

Yea? Do you know which one? How?

don't know the name

by Tracey_E - 2008-12-09 08:12:54

I'm not sure what they call it! I only know I have it turned on because when I work out I suddenly go from 160 to 120 then back to 160 again. Your hr can slowly drop but it prevents large sudden drops. I have an appointment tomorrow, I will try to remember to ask.

halving

by Tracey_E - 2008-12-10 02:12:26

Frank, I think that's the setting that he just had turned off. There is another setting that prevents sudden drops in atrial rate. I had both problems- atria got over my set max (170) so it threw me into a 2:1 block, but also chronotopic incompetence (I think that's the correct name) where your atria is cruising along at a high rate during workouts, suddenly drops off, then shoots up again. They were able to do something- no idea what they called it- to make sure my rate only drops slowly.

HR Halving 2

by ElectricFrank - 2008-12-10 10:12:31

Tracey,
The operation I referred to is the way Ventricular Upper Limit operates. He mentioned having his upper limit set to 180 so this is inherent in the setting. It seems to be confirmed by his report of a sudden drop to 1/2.

I suspect that what was turned off is the PMT (Pacemaker Mediated Tachycardia) Intervention function.

This stuff is complex. If I didn't have the Medtronics technical manual for my Kappa 700 series I would be lost. Even with it there are so many additional functions in other models and manufacturers.

enjoy the upcoming holidays,

frank

HR halving

by ElectricFrank - 2008-12-10 12:12:19

This is perfectly normal. You have the right idea about the pacer not handling all the pulses. This is the way the upper limit operates. So when you exceed 180 it starts skipping beats to enforce the limit. This is the only way it can handle it and keep the ventricular beats in sync with the sinus beats. So when you top 180 it will pace the ventricle on every other beat which is 180/2=90. I like to describe as limiting a car engines top RPM by pulling off spark plug wires. The other thing that makes it more difficult is that most HR monitors don't deal well with this erratic heart beat.

I wouldn't recommend pushing it to this point. The problem is that at the point when you need the high HR to support the exercise level your heart drops to a much lower rate. You may be able to talk the doc into increasing the rate to 190-200 after a few more months of successful operation at the current rate.

I am 78 and in good shape. My initial settings were 70-120. You can imagine trying to even take a moderate walk. I used a HR monitor to stay about 5 bpm below the upper limit because there seems to be an overshoot when I stop. Then I after some strong insisting I got successive changes to 55-150, which is reasonable for my age. I convinced them that I wasn't going to operate at 150, but wanted some leeway in case I was chased by a bear!

enjoy,

frank

... continue

by llobet - 2008-12-11 06:12:50

First of all, THANKS!

I’m not so expert in PM so I have a couple of questions. Why do I have to wait a couple of months to increase the rate? Is there a way that my PM is “reading” better the pulses with the time? or it’s a question of getting use to the missing beats at these high rates?

(my PM is a Medtronic Kappa KDR703)

Take care

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I have a well tuned pacer. I hardly know I have it. I am 76 year old, hike and camp alone in the desert. I have more energy than I have had in a long time. The only problem is my wife wants to have a knob installed so she can turn the pacer down.