Pacer art/ hystersis

Hi to all, I am new to the froum and just had a couple of questions. I had a guidant pacer inserted September 1st for symptomatic bradycardia. I saw a cardiologist and an EP and they could not give me a more definitive diagnosis. I agreed to the pacemaker because driving was becoming unsafe (dizziness with drop in HR) My resting heart rate rarely went above 40 and at night would drop into the low 30's but I was able to elevate my HR while exercising. Anyways, my question is this, prior to my pacemaker being implanted my EP was going to program my pacemaker to have some hysteresis so that as long as my heart was behaving it could drop below the set rate of 60. During the insertion and testing, they were unable to add this feature and I would guess that I pace 100% of the time curently. I will not have my first interrogation until October 12th. I am set up for a "pacer art" appointment. I am not really sure what pacer art is, any insight? The first week after the surgery I felt that the 60 was to high of a setting but now that I have gotten used to it, I have not felt better in my entire life. The whole world seems crisper and brighter to me and I am amazed at how fast the recovery was. ( I am back to all of my normal activities including long distance running). I am now worrying that when they "tweak" my settings it will be a new adjustment. Also, how does rate response work? I thought that my HR would drop slowly after exercise instead of the sudden drop I had before the pacemaker but after running this weekend within 20 minutes of finishing a 6 mile run my heart rate had returned to 60. Wow, sorry for the lengthy post, guess I am full of questions! Oh.. and I do not take any medication in case that helps!

Thanks!

3 Comments

Thanks!

by Drin6969 - 2009-09-23 10:09:48

Thanks TraceyE. You explained that very well. I will post my readings after my interrogation, I am sure the readings will be as clear as mud to me! I must agree, oxygen truly is an amazing thing! With the rate response, will it sense that your exercise intensity is increasing and bump up the rate or does it just allow your heart rate to raise on its own? My upper limit is currently set at 140, I never went above 130 before. Thanks again for the info!

welcome!

by Tracey_E - 2009-09-23 12:09:39

Welcome to our little club!

How nice to hear that you're feeling so good!!! Oxygen is an amazing thing.

20 min to get back to normal after exercise is great, perfectly normal.

I never heard of pacer art! Did they mean interrogation?

Unless you have a problem and they are trying to reprogram to fix it, you should feel the same after they tweak it. Most tweaks are to maximize efficiency and extend battery life. As they watch how you use the pm, they can make it work better for you.

Symptomatic bradycardia doesn't tell you much. Symptomatic means you had symptoms, bradycardia means your hr was low. That's a symptom more than a diagnosis. Two main reason for bradycardia that are treated with a pm are sick sinus, where your atrial rate drops off at rest or doesn't go up with exercise, or av block, where your atria works just fine but the signal doesn't get through to the ventricle. This is a guess, but from what you described I'm guessing you have sinus issues.

I don't know what feature they couldn't add but I can tell you how all pacers work. They have bells and whistles and timing that can be adjusted but they all basically work the same way. Our hearts beat on their own, think of the pm as a watch dog. To keep the math simple, let's say you're set at a min of 60 bpm, or 1 beat per second. The pm will watch for your heart to beat. If it goes a second without beating, it will generate a pulse and make an atrial beat. This is atrial pacing. The atria (sa node) tells the av node in the ventricle to beat. If the atria beats but the ventricles don't follow, the pm will generate a pulse and make the ventricle beat. This is ventricular pacing.

Rate response is one of those fun bells and whistles. If your heart doesn't go fast enough with exercise, a rate response pm will sense that you are moving and exercising and it will raise your atrial rate. If you pace ventricular, you don't need rate response because your sa node will already know you're exercising and need to beat faster.

When you go for your pacer check, ask for a copy of the report. A few of the guys here can decipher it for you.

rate response

by Tracey_E - 2009-09-24 06:09:36

The upper limit should always be set above where you normally work out so you have a nice cushion. I get in the 160's when I work out (we know this from a stress test), so I'm set at 170.

My hr was in the 40's all my life, mid 20's the day I got my pm. With the pm, I rarely go under 80. Those first few months it felt like I was on a coffee iv! I was working out twice a day just to burn off enough energy that I could sleep at night. (add 15 yrs of aging and 2 kids and I don't have that problem anymore, lol)

A rate responsive pm senses movement and raises your hr. It has several sensitivity settings, and odds are good it will take a bit of experimenting to figure out which setting is right for you. Higher sensitivity will go up more with every movement so it will be more sensitive to an intense workout, but this setting bothers some people because it thinks they're working out sometimes when they're not (like driving down a bumpy road) and you may not need the higher level of sensitivity.

Technology is amazing, but it's still not an exact science! Don't get worried that something is wrong if it takes a few tries to get it right, it's perfectly normal. Most pm recipients are not otherwise healthy and active. Those of us that are, we are higher maintenance and make the pm work harder and have more exact settings than someone who mostly sits around.

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