Highest setting at 150 bpm?

Hi again All. I'm not allowed to exercise yet, but in two weeks I'll be ready to go back to the gym according to my doctor. My concern is my EP told me that the highest setting on my pm was 150 bpm. If it goes over 150 it will automatically drop to 70 bpm. Did I hear him right? That's a pretty big drop don't you think? What will happen if I hit 150 while on the treadmill or any other exercise? Will I pass out? Will I get dizzy? I was scared to push myself BEFORE my pm because of my slow heart rate, now I'm even more scared to push myself because I'm not sure of what will happen if I hit 150? Any thoughts? And thanks in advance.

12 Comments

heart rate monitors

by Tracey_E - 2010-03-24 08:03:01

heartu, check it out before you leave the store! Some members have no problems with hrm's but many of us cannot use them. In my case, the pm signal interferes with the hrm signal and it always says my hr is 0. I'm pretty sure it's a little higher than that! Other people have the opposite problem- it picks up their hr as well as the pm spike so the number is very high. After I returned the second one, I started asking to try them out on the dressing room. They usually don't want to do that, but once I told them why they were all nice about it. I never found one that worked for me other than a ring that uses infrared, but it's too clunky to wear while working out.

Heart Rate Monitor

by heartu - 2010-03-24 08:03:09

Hi Dana,

I'm waiting to read the responses you get. My high setting is currently 130 and I haven't gotten there yet, because my EP told me to wait before I push my HR that high. But I know 130 is too low for me, but I never went over 150 (I'm 53) before the PM. I didn't realize that PMs couldn't go above 150.

Out of curiosity, will you use a heart rate monitor to keep checks on your HR? I am thinking of getting one.

Also, when do you go back for your next check-up?

maybe

by Tracey_E - 2010-03-24 08:03:19

You could have heard him right but I don't think he did a very good job of explaining it! There is a safety feature on some of pm's that detects afib and puts you into an artificial 2:1 block to keep the pulse down during fibrillation. It only paces once for every two atrial beats. It's great if you fibrillate because you don't want your hr suddenly shooting up at random, it's annoying if you just happen to get that high working out. If you have no history of afib, they should be able to turn this feature off, end of problem.

How high do you get when you work out? You may not even get close it it, which means it's likely not going to be an issue for you. My max rate was 140 for years and I never had a problem with it, I was consistently in the 130's when I worked out. Last year I suddenly started getting up to 180-190 during exercise, that's when I learned all about max rates and afib safety features, lol.

I've had it happen, hit the max and hr suddenly drops off. It doesn't feel good but it's not awful either. I just got really dizzy and suddenly felt tired, I did not pass out. Between the beta blockers and settings changes, I can push as hard as I want at the gym now and have not had any problems with hitting my upper limit (knocking on wood).

I could be totally off base but I thought most of them had a max rate of at least 180, one or two go as high as 220. 150 may be what you're programmed at but I thought most pm's could be programmed higher. Mine goes to 180 and is set to 175. Just cuz I think it, doesn't mean it's fact! But ask if that' s how high you're set, or how high your model will go.

Something to keep in mind... a lot of EP's and cardiologists don't have more than a few young and otherwise healthy patients so workout problems are not something they deal with very often. My dr is great, but totally clueless about dealing with me when I have exercise problems. I'm lucky to have a totally awesome St Judes rep who's willing to research it and find creative solutions. What I'm saying is, don't take what he said at face value and don't give up easily. Ask if that feature that causes the rate drop can be turned off. Just because he may never have done it before doesn't mean it can't be done!

And don't let this keep you from working out!! It's annoying, not dangerous. Worst case, you get dizzy and have to stop for a few minutes til your hr comes down again. I worked out this way for more than a year. I'd workworkwork, max out the pm and get dizzy, slow down and stretch ( or on occasion sit with my head between my knees, lol) til I felt better again, then get back at it and finish my work out.

Advice

by jvaltos - 2010-03-24 09:03:53

SO the real problem here is that you are likely to go faster than the programmed upper limit (aka maximum tracking rate (MTR).) What needs to happen is that the device should be programmed with the highest tracking rate possible suitable for your age (also need to sure that you have no ventricular tachycardia.)

In addition, there is something called the Total Atrial Refractory Period (TARP) which is essentially when the atrium can not pace. This can be programmed to be shorter than the MTR. Complicated, but it will often allow for you to NOT go abruptly to 2:1 (ie 150 to 75) and will cause a slower skipping of beats.

If all else fails, it is possible to have you exercise and while you do it on a treadmill in the office, change the settings and repeat.

Good Luck-You can be reprogrammed.
JV

Been there done that

by Jmiller - 2010-03-24 10:03:29

My dual lead PM came with a factory limit of 140. What I found out was when I went over 140 on an exercise bike my pulse rate went crazy. What I found out was it went into 2:1 heart block mode until my rate dropped down a little. To answer you question, I felt nothing bad just may pulse felt wacky. Dr reset my PM limit to 160 and took off the 2:1 block mode. I exceed that also at times playing hockey but the Dr said it is not a problem unless it makes me feel bad.

Unknown Max

by Dwight - 2010-03-24 10:03:36

All I know is mine was raised to 160 today, I don't know what the maximum mine can be set to. (This is my 2nd increase). I went out and ran as soon as I got home but basically couldn't tell any difference. I know I need to learn all these terms and abbreviations on my 4 page printout before I can understand them. It might as well be in Chinese because I simply cannot read or understand it.
Good luck as you get back exercising. Be careful!
Dwight

Thanks again

by DanaT - 2010-03-24 10:03:53

Thanks again all. I understand what you're all telling me but I still find it a bit confusing. My next appointment is in 2 months. One of the reasons I got the pm was because I would get dizzy during exercise. So much for that being fixed, lol. I did very light exercise today and after about 10 minutes my hr was at 100 bpm so I have a feeling I will hit 150 easily. Of course I'm pretty out of shape right now. I guess I'll just take it easy and ask my cardiologist on my next visit. Uugg, this is so frustrating!

Question the EP

by ElectricFrank - 2010-03-25 02:03:01

I suggest asking the EP directly whether he means the pacemaker is not capable of being set higher than 150 or that he means that the programmer sets it at 150 based on your age, etc.

I am fortunate to be able to have the technical manual on my Medtronics so I can look up these things myself. Early on I had a few of these erroneous statements and was able to point out the page number in the manual that covered it. I've also supplied the info to a few forum members in Private Messages and they found the same thing. I won't speculate on whether there was an intent to mislead me or just a lack of knowledge.

My concern with hitting the upper limit is that it is not a good thing for our heart or bodies. At a time when we are exercising at a level that requires the high HR to supply adequate blood flow, the pace drops the rate suddenly. It doesn't matter whether it drops it in half or by a smaller amount, the effect is not good. Just thing what would happen if at the peak of your exercise you suddenly started breathing slowly.

So why does it operate that way? The purpose of the upper limit is to prevent conditions such as afib from pacing the ventricles at a high rate. However, if like me, you don't have such a condition then it is not needed. I am 80 yrs and still have my upper tracking rate set to 150. I never come anywhere near it, but his assures I can't hit it either. Like I told the cardio, if I am being chased by a bear I don't want to become a meal (without tachycardia). LOL

frank

180

by Heapy - 2010-03-25 06:03:16

Hi

I am 54 and had a PM implant last new years eve (09). I returned to training but when I reached 150 it felt like my chest was being crushed. I went back to the PM clinic and was re-programmed from 150 to 180. This now allows me to continue with my running & other sporting activities with no problems. - Don't know what it's like in the US but the UK NHS were absolutely great, one phone call and I was back in the following day for re-programming.

All the best - keep at it, and your fitness will slowly return

Paul (UK)

Check this out

by heartu - 2010-03-25 09:03:33

Dana,

Don't know if you know about this site or not. It has a Max HRT calculator for cardio/pacemaker people. It does state "The best and safest way to discover your maximal heart rate is to have a Graded Exercise Test (GXT) in a hospital setting where your ECG and blood pressure is monitored throughout the test by medical professionals."

http://www.cardiacathletes.org/HRRCalculator

Same site, this page talks about pacemaker athletes:

http://www.cardiacathletes.org/FAQRetrieve.aspx?ID=33766

Hope this helps.

cardiacathletes.org info

by ElectricFrank - 2010-03-26 12:03:52

These sites seem to have good information. I would suggest reading the FAQ page first before using the calculator. The accuracy of using the pacemaker settings as the calculator recommends is dependent on the pacemaker being properly programmed, which as many of us here have found, is often a bad assumption.

The exercise test is certainly the best way to determine pacemaker settings especially if you have SSS and need Rate Response turned on. For those of us with simple block there is really no more reason for the test than for those without pacers. With my upper tracking limit set well above my 80 yr old natural upper rate I just pay attention to how I feel. However, most Jocks are into pushing on and probably need some kind of number to stay under.

frank

same concern here

by irisheyes317 - 2010-03-28 12:03:51

But was told mine was set at 140. Which scared me, going to the gym as well. My EP cleared this up by saying that even if I overworked on the treadmill, it would be very hard to get my HR up to 140, because of the PM. He aslo said that IF I managed to get it there, then my device would kick into a mode where it would run a series of 3-4 "pacing patterns" to get my HR down. If then it didnt come down, I'd get "kicked", but only if my HR reached 200. So there is a margin there. You may be set at 150, but that doesnt mean if you get there, you'll get a jolt. The PM/ICD is programmed to sync when you are not. To those of us who are very active or work out, our HR may increase, but our devices are set to accomodate that. I hope this makes sense. It certainly put my mind at ease. But you may need further clarification form you Cardiologist or EP.

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