Puzzled about rate response

Six months after having my pacemaker implanted for complete heart block I was still having difficulty exercising (swimming, walking and cycling) I was easily out of breath, often lightheaded and the most simple physical tasks like going upstairs or hanging out the washing left me exhausted. (I am 49 and otherwise very healthy!) I didn’t feel much better than before the PM, although there were some differences: my fingers and toes were warm for the first time in my life, my lips had lots more colour and my eyes could focus better.
At my six month check in March I was told that I was pacing 100% in the ventricle and 5% in the atria, the pacemaker was working well and doing its job so my problems were probably due to the fact that I hadn’t been able to exercise for so long before I had the pacemaker and had therefore become unfit. I accepted this and went home determined to exercise more. I tried very hard but I seemed only able to swim two lengths of the pool before needing a rest where previously I had swum 60 lengths continuously; walking was ok providing the ground was flat but any slight incline stopped me in my tracks and I could only manage a couple of minutes on the exercise bike before my legs started to burn and I felt exhausted. It seemed as though I was hitting a wall that was stopping me getting fit. I managed to get an appointment with the Dr. who had implanted my pacemaker. He was puzzled and sent me for a variety of tests. Last Monday I had a treadmill test - I only lasted 4 minutes and the technician was able to see that my heart rate rose to 113bpm and then dropped right back to 60bpm (my lower limit). It appeared that every other beat was missing. So I was right that I was hitting a wall as every time I started to exercise my heart couldn’t keep up. I asked about the "rate response" which I thought meant that the pacemaker would sense my needs but the technician said that as I had been diagnosed with complete heart block my pacemaker was set to pace the ventricle as it sensed the atria working and that my atria would only be paced if it went below 60bpm. I am going back on Friday to see what can be done.
I am confused about the rate response and wondered if anyone could explain this to me. I am also a bit concerned that there now seems to be a problem with the atria which wasn’t found before. Does this mean that things are getting worse?
Best wishes
Pollyanna

9 Comments

Oh my gawd........

by Pookie - 2010-06-15 04:06:41

hi.

I have been experiencing the exact same problems as you and cannot get an answer....please post if you find the answer.

I need my life back!!!!!!!!!!!!!!!!

Pookie

rate response

by sam78 - 2010-06-15 06:06:05

Here goes... I will try for you two..

"Rate responsive pacing allows the device to sense the physical activity of the patient and respond appropriately by increasing or decreasing the base pacing rate "

Each pacemaker is a little different with how it senses the need for rate (such as increase in respirations or movements, etc).. but if is senses an increase and your heart rate does not respond... then the pacemaker will pace you to give you determined heart rate. Rate response has several settings that can adjusted.. like how quickly the rate increases, how sensitive it is, etc. For example... if you were sitting on the couch and you were pacing or had a natural heart rate of lets say 60 and you got up and ran up a flight of stairs, and your heart rate did not respond.. the pacemaker would sense that you were doing some activity and would increase your heart rate gradually to a higher rate. And then when you stopped it would slow go back down. It is very complicated algorhythm that determines what it increases too which I am sure you arent interested in. So you sit on the couch your heart is 60, you run the flight of stairs it may increase your heart rate for example to 90 and then when you stop it will go back down to the 60. Rate response only kicks in when it senses that you need it, like if your own heart rate does not increase.

There that is my best attempt.. Questions?

Me too!

by Rubies61 - 2010-06-15 07:06:44

Pollyanna, I am also 49 and have a similar situation.
I have 2nd degree av block mobitz I - at least that was what I was told. At this time my pm is pacing 90+% in the ventrical and not so much in the atrium. I received the pm for exactly what you stated. When I exercized my hr would drop. I started it out with it pacing a small percentage both vent. and atrium, but now I am almost pacing all the time. My cardiologist told me it could have progressed and so it is a good thing that I have the pacemaker.

After my first pm check I told them that I was still getting shortness of breath. They turned on the rate response. Now they said they did it 'a little bit'. I don't know what that means but it did help as I can now go up a flight of stairs without gasping for breathe.

I had injured my ankle and was limited in my exercize for a year but am now out and walking - hills, etc. My first day out I hit that wall! But I have seen some improvement. I know I am very out of shape so improvement is good. I may have them adjust further, but am not rushing in yet as I don't want my settings messed up either. But I may change my mind.

Good luck and let us know how it turns out Friday.
Sandy

P.S. Sam78 - thanks for the rate response explanation!

I have complete heart block too.

by heartu - 2010-06-15 08:06:45

I do not have the rate response turned on since I did not need it for third degree heartblock according to my EP. Check first if you rate response is on or off.

When I first started exercising after my pm I would get my heartrate up to at least 130 and then bam! I started to feel lousy. Apparently the Upper Rate of my pm was set to 130, meaning that if my HR went above 130 the pm would put me into a 2:1 block to slow me down. Felt extremely lousy. I told my EP about this at my 12 week appointment and looking at my interrogation report he raised the Upper Tracking Limit to 150.

I am 53 years old and was pretty fit before I had the pm put in.Since I was fairly inactive for the first 6 weeks after my surgery, I started out exercising slowly. First walking numerous times during the day (short walks/slow pace). Then I started to walk more and more. I now monitor my workouts with a heartrate monitor, to make sure I am not pushing myself too hard, because working out too hard too fast will make you feel lousy also. Your body needs time to recover after working out. Now I am more conscious about my HR when I work out and try to keep my exercise sessions at the appropriate levels for my age (50-70% of my target HR) to keep fit.

Doing 2 laps in the pool after not being too physically active for a while is pretty good. Pace yourself and don't try to become an athlete overnight.

no rate response needed for heart block patients

by golden_snitch - 2010-06-16 03:06:58

As heartu said, there is no need to have the rate response turned on when you suffer from any type of heart block "only"; it's for those who have a sick sinus node. As long as the sinus node works, it will do the rate response, and the ventricular lead of the pacer will just follow the rate from the sinus node. If it doesn't or if the sinus node is not responding well to exercise - do you take any meds that would slow it down? -, you should have that checked out with a treadmill test or wear a holter when exercising (or just walking stairs etc.) so that one can try to correlate your shortness of breath with your heart rate.

Best wishes
Inga

rate response

by Pollyanna - 2010-06-16 05:06:51

Good morning all
Thank you to all who have replied to my posting overnight (UK time), it seems there are a few of us having similar difficulties.
Thank you Sam78 for your explanation which matches pretty much what I thought should be happening. I thought the rate response was automatically on with my model of pacemaker which is St Jude Medical 5826 DDDR mode. But from what happened on Monday this may not be the case.
Hi Heartu I wondered if I too was reaching my upper limit when I was exercising but as I only reached 113bpm on the treadmill before it dropped back to 60bpm I don’t think that this is the case as my upper limit is 160bpm. Thank you too for you advice on exercising it sounds as though you are gradually getting back into shape.
Hi Inga, I am not taking any medication, but what you say fits with what the PM technician told me when I asked about the rate response as he said that as I had been diagnosed with complete heart block my pacemaker was set to pace the ventricle as it sensed the atria working and that my atria would only be paced if it went below 60bpm. He said that it does not sense my body’s needs. So it looks as though the rate response is not on.
Thank you Pookie, Magster and Sandy, hopefully I will get some answers on Friday. I’ll let you know.
Best wishes
Pollyanna

rate drop response

by Tracey_E - 2010-06-16 08:06:29

If your upper limit is set to 160, then something else is going on when you get to 113 and suddenly drop, you have plenty of cushion. It could be chronotropic incompetence, when your heartrate doesn't keep up with exercise. There is a feature called rate drop response that controls how quickly our rate drops off and can prevent the sudden drops.

Whenever I've had problems working out, I've had a stress test. Get on the treadmill and let them watch what happens on exertion, a quick and easy way to see what the problem is and tweak the pm settings to fix it. I have chronotropic incompetence also but having third degree block masked it until I got the pm. Without the pm, my hr never went up with exercise so we had no idea I had the second problem until I ran into problems exercising. It was an easy fix and I can exercise all I want now.

Have you ever asked for a copy of the printout? That can tell you what your settings are and for sure if rate response is on or not. DDDR- the R stands for rate response. Sometimes they leave it on and assume we won't use it when we have heart block, but that's not always the case. Sometimes it can kick in and compete with our natural hr. That can cause problems, but not sudden drops. It's more likely it would cause sudden jumps.

Good luck getting it fixed! Sometimes it can take a few tries to get it just right, but when we have CHB, there's no reason they can't get us feeling 100%! It might take a little effort, but you'll get there.

Hmmmmmmmmm I dispute!!!!!

by Hot Heart - 2010-06-17 06:06:37

I have 3rd degree total heart block, age 57, was, or thought I was fit, healthy, did gym, dancing, hiking, swimming etc.

For the first year my rate response was off, I struggled to walk up hill, to run, to do anything which would normally raise the heart rate quickly.

I always park my car at the top of a hill by the hospital, parking is cheaper. Every appointment I struggled to walk back up the hill. I had an app with my cardiologist on the Wednesday, struggled up the hill as usual.

The next day...........hallelulja!, the first day of my new life, I had an appointment for interrogation. Asked the tech to turnmy rate response on. She was hesitant to do it, said I didnt need it, said I probably wouldnt like it. She said, you'll be back tomorrow asking for me to turn it back of.

NOOOOOOOOOOOO I WASNT!!!!

I left the hospital, walked straight up the hill, picked my daughter up, went to the NIA in Bham, ran up the stairs from the car park because we were late, danced to the Nolans (OK dont laugh, yes the Nolans!) all night and........................havnt looked back.

Sooooooooooo, 3rd degree heart block, rate response on and...................I LOVE IT!!!!!!!

HH

Rate Response

by DMAC - 2013-03-05 03:03:51

I had my P/M implanted on 2/14/13. I'm 57 and before I had the P/M, I played softball and worked out three days a week. I'm not familiar with the P/M except I was told that it would work as "On Demand". I'm reading about "Rate Response" and wondering if this is two different functions that the P/M does? One day before I had the P/M put in, I did a stress test and passed with flying colors. No problem with my heart rate going up. The problem is that my heart rate was going down, and that is the reason for the stress test. I can be sitting in a chair and my heart rate just goes up with movement, or walk across the parking lot and it goes up to the mid 80's to the mid 90's and I get a slight pain in my chest around my sternum, then it goes away. It's uncomfortable when this happens. The Dr told me he could put me on Beta Blockers, but I don't won't to take medicine for someting that will hide some pain. Any suggestions?

Thanks

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