Pacemaker settings for sports and fitness

Hi, I am a 56 year old male that is a life long runner and cyclist. I am due to have a pacemaker implanted in 3 weeks. The whole saga started about 6 months ago and I have had 3 ablations to successfully treat atrial flutter and AFIB. I have also been diagnosed with sinus node dysfunction, ie slow conduction. I had one black out episode when I transitioned out of AFIB, and was told that this condition would likely get worse even with the AFIB successfully treated. Also have cardiomyopathy, a slow resting heart rate that is between 35 and 40. Heart rate has always been this low and was aware of it when I was in my mid 20's and using a HRM back in the 1990's. My question is what heart rate should the pacemaker be kicking in? I do get the odd dizzy spell when I get up and move around after sitting at my desk, also notice that I get unusually breathless when I start to walk stairs etc, it takes a while to get going, once I'm up to steam I'm fine and can go all day.  Also my heart rate maxes out at about 140, will the pacemaker allow it to beat higher?




Pacemaker settings for sports and fitness: it will be trial and error

by Gemita - 2023-03-08 02:39:29

Bikingsteve, it will be trial and error to find the best upper and lower rate setting that will suit you.  

You ask, what heart rate should the pacemaker be kicking in at?  

My answer would be at a level that “feels” right for you, that allows you to carry out your daily activities comfortably without any risk of fainting or feeling weak or experiencing other difficult symptoms of a too slow heart rate and at a rate that allows you to “rest” comfortably too at night. 

If the lower rate limit is set too high you might find it difficult to sleep for example.  Only by working with a sports/cardiac technician to test your reaction to a slow heart rate in both circumstances - when at rest and when active - will you know what “feels” to be the right setting for you.  

I also used to experience fainting episodes due to pausing when I converted out of AFib back into normal sinus rhythm, although I see that your AFib/Flutter seems to have been treated successfully by the ablation but leaving you with slow conduction/sinus node problems.  

I note you have cardiomyopathy also and that your natural resting heart rate is between 35 and 40 bpm, so you certainly don’t want it to be set too much higher when you are resting, perhaps 45 bpm at rest and 60 bpm during the day might be reasonable to start with but work with your doctors.  A higher heart rate should help keep any premature beats under control, help to prevent the odd dizzy spell and breathlessness when walking upstairs or when first exerting yourself.

You also ask, my heart rate maxes out at about 140, will the pacemaker allow it to beat higher? 

Any upper rate limit setting will not prevent your own heart from going higher during exercise if it needs to.  The upper rate limit setting is the maximum rate your pacemaker will help you to reach if you need help during exercise/acceleration.  The upper rate limit setting can be negotiated with your doctors if you feel you don’t have enough power.  Sometimes they like to keep it lower due to age, level of fitness, a heart/health condition, as well as in the presence of any tachy arrhythmias for example, in case this triggers worsening symptoms.

So it will be trial and error, working on a treadmill and with a sports/cardiac technician to find the most suitable and safe upper and lower levels for you.  There isn't a good or a bad rate, it is all about finding a rate that will be right for you.


by Tracey_E - 2023-03-08 08:35:24

The first thing you need to do is make it very clear to your doctor that you cycle. The pacers use rate response to raise our rate on activity, so yes it should be able to get you over 140. However!! Many of the ones on the market use our motion to detect exercise. On a bike, the chest isn't moving so cyclists with sinus dysfunction are a bit of a challenge. There are other options for devices that do not rely solely on motion, make sure they give you one of those. 

A typical lower rate is 60 but some people feel better with it 50, some feel better at 70. That part can be just a matter of trying it out and seeing what feels best. People who have had a lifetime of a lower rate tend to think they won't like 60, but give it a chance. My rate was never above 44 my entire life until I got my first pacer so 60 felt very fast at first. But I was also full of energy like I'd never known before, so we left it there and I got used to it. 

Know that with athletes, it is common to take a few tries to get the settings fine tuned. This doesn't mean it's not working, it just means each of us is different and settings are not one size fits all. If you ever don't feel right, go back and have them make adjustments. 


by Bikingsteve - 2023-03-08 20:34:10

Thank you both for your advise, I am due to be fitted with a meditronic which uses an accelerometer for response rate, so I'll be talking to my doctor about this. Hopefully will be able to get the Boston Scientific one instead.


by Tracey_E - 2023-03-10 09:30:32

You will struggle on the bike with Medtronic. Boston or Biotronik might be a better fit. The challenge there is they are only as good as the programming, so if your doctor isn't as familiar with them and programming them for athletes, you may need to find someone who is. But the place to start is getting one that doesn't depend on the accelerometer. 


by Bikingsteve - 2023-03-11 22:37:27

Have spoken to my cardiologist and he has agreed that the Boston Scientific will be the best for me. Really appreciate the comments and advise!

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I am just thankful that I am alive and that even though I have this pacemaker it is not the end of the world.