Settings?

In an effort to start getting in shape again and try out my new settings and meds, I have started walking/running at night. Tonight was the first night I used my HR monitor and have a concern.

My settings are 60-135, RR off, sleep mode 50 which starts at 9:00 pm. Tonight I look a late walk 9:30 pm. When I first started my walk I was in the 60's and felt fine. I noticed as I started to run my HR would not reach above 75. Ok, dealing with that. I knew with my new settings and meds getting my HR up might be an issue. However, 20 min. into my walk/run my HR quickly dropped to 35 then slowly crept back up to the 70's. Thinking it was my monitor I stopped by the house and used my cuff and the watch was accurate. I continued to walk now just curious if that was a fluke and it was not. I continued to drop.

I can understand that the PM may have been pushing my HR down but I don't understand how it could push it lower than 50 BPM? Obviously when it happened I had undesirable symptoms lol! I'm not exactly sure how the sleep mode interacts with increased HR and if there is a range. Either way, I was never able to get my HR anywhere near the 135.

I failed to say I'm on Flecainide and the recent added medication is Toporol XL. I have a dual lead PM after an AV node ablation.

In addition to this I have also had swelling in my legs the last several days, it seems to cone and go. I'm not sure if this could be related.

2 Comments

Either sinus node or mode switch

by golden_snitch - 2011-08-21 03:08:36

Hi Heidi!

Could either be that Toporol lowers the sinus node rate a little too much. With the RR off, the pacer can't really do anything about that, it will just follow that slow sinus node rate.

Second cause for the 35bpm could be that you reached the upper rate limit of 135, and the pacer therefore stopped tracking the sinus node rate, but went into mode switch with a 2:1 block. That means, if your sinus node makes a rate of 135 or even more, the ventricular pacer lead will stop following this rate, but will only give one impulse for two impulses coming from the atriums --> you end up with a rate around 70. Easy to fix by increasing the upper rate limit. Know quite a lot of AV block patients who have had this problem in the beginning. Don't really understand why doctors often program the upper rate limit so low in patients who have nothing but a heart block (in heart failure patients that is ok).

Hope you get this sorted out.
Best wishes
Inga

Thanks Inga!

by Heidiglassmeyer - 2011-08-21 10:08:31

My upper limit was recently lowered, was at 180 however had been dealing with frequent AT. Would be around 120 most of the day. Would have episodes above 150 and would get SOB, chest pains, and near syncope. Had to go to the ER a few times when I could not get it down on my own. So, instead of another EP study we decided to add the Toporol and lower my settings knowing that I would have an exercise limit.

That was why I had the hr monitor on so I could pace myself and not reach the 135 limit. I thought it was strange that I never got close to my limit when it dropped.

The one factor I'm not sure about is if the sleep mode has a range or not. That could have certainly added to the issue.

After I posted my resting HR was all over the place. Would be in the 60's then jump to the 90's, then into the 80's, etc.

I had a discussion with Frank at the time of my last setting change trying to figure out what my best option would be. I think one option that I have not tried is the RR on. I really don't know enough about it and if it would work in my situation. Any thoughts?

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