Getting back to normal

I had a PM fitted 2 weeks ago, for sinus bradycardia (SSS) and right bundle branch block. I'm 49 and fairly fit (cycling, squash, football, running etc), and would be interested to hear about how other people have found getting back to the same level of activity, and any advice on how to get the PM calibrated right (it's a Boston Scientific Accolade, two lead, rate responsive, though RR not switched on yet). I've never used a heart rate monitor for cycling before, but is it useful to get one now? And is it worth wearing something like a Fitbit full time so I can work out what the upper limit setting for the PM should be, once I get back to proper exercise?

My other question is whether other folk have been left wondering how necessary the operation was. I had had a very busy week and overdid it on the both the work and execrise front, in a spell of hot weather. I felt midly lightheaded a couple of times (once on a long hike, the other just at home running upstairs), and so went to the doctor just to get checked out as this seemed unusual. My RHR is 40 (which seems not unusual for cyclists), but was 32-40 when monitored in the hospital. The consultant advised a pacemaker straightaway, insisting that my symptoms would only get worse, and that blackouts were likely to happen in the future. But apart from those very minor episodes, it seems that I'm a long way from suffering the kind of debilitating blackouts or fatgiue that I've read on this forum. Or am I just deluding myself, and I should feel lucky that this potentially dangerous condition was spotted early before any harm was done?

7 Comments

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by WiredandTired - 2017-07-09 05:54:31

Im 49 too.  Plan on six weeks before you start to feel more like yourself again.  I'm over 6 weeks in and have resumed my normal exercise level but still have off moments and days.   Chest still feels like its healing.   My rate response was left off and I was exhausted.  They kicked me up from 50/120 to 60/150 , turned my rate response on and it made all the difference.   We have the same pm too.  

About Cycling

by Shaun - 2017-07-09 08:53:16

I didn't want to get straight back out on the bike after the implant because of the risk of falling off the bike and dislodging the leads. I wanted to remain in total control of my movements and so I spent several months regaining my fitness and confidence on a turbo trainer. I also bought a Garmin ANT+ heartrate monitor that connects to my Garmin cycling  SatNav, but I've only ever used it a handful of times. For my condition (Bradycardia due to SSS) my cardiologist recommended that I let my body tell me how hard to push it and not to bother with any monitor. That may not apply to you though.

paced life

by Tracey_E - 2017-07-09 09:49:24

If your resting rate was as low as 32, you needed it. Overdoing it and being tired doesn't cause the heart to beat slower, but it does mean we feel it more when it happens. Unless you happen to have a crystal ball, waiting until you are passing out is waiting too long. My rate dropped to  22 the day I ended up in emergency surgery. I could have died, but I did not pass out. We've had members fall down the stairs or wreck their cars, then found themselves recovering from those injuries as well as pacer surgery. Have faith that it was the right choice.

Don't be surprised if your new resting rate is higher than 40. Often they write a low rate off to being athletic when we don't have symptoms, but a resting rate of 40 is very very low no matter how athletic you are. The body needs oxygen, when the rate is that low either the body is being deprived or the heart has to work a lot harder to supply that oxygen.  

Heart rate monitors are notoriously inaccurate with us so I haven't bothered. Like Shaun, I learned to listen to my body. If I can talk but not sing, if I am sweating, if I feel strong, I can assume my rate is good. I used to count sometimes but now only do if I feel bad. Even then most of the time I don't bother, I just cut back a bit until my breathing slows and I feel good again. Sometimes this is 130, sometimes it's 160. The target hr charts don't appl to us most of the time so don't get hung up on it.

If you are exercising and have symptoms, initiate a download if you have a home monitor or call and ask to be seen if you do not. They can tell what the pacer was doing at the time and adjust the settings accordingly. Know that it's normal to take a few tries to get it right. We are all different and settings are not one size fits all, and the more athletic we are, the trickier we are with the settings. If it takes more than a few tries, ask to get on a treadmill at the office while on the pacer computer. Saves a lot of trips back! 

If a lead is going to come lose from our activity, it'll most likely be in the first 24-48 hours. They can very rarely come loose after that, but it's more likely because it was in a bad spot to begin with rather than something we did.  Restrictions are precautionary and more surgeons are easing up on them. I got my first in 1994, my 5th last year, so I've seen the changes first hand. That said, don't get back on the bike just yet. Infection is a bigger risk than leads coming loose for the first 4 weeks. After that (and when you are cleared by your doctor) ease back into your old training routine. 

Beware of jumping exercises

by angelwink - 2017-07-10 15:01:27

I had SVT for a long time before diagnosed. My heart can reach 260bpm, which for me caused heart failure (it usually doesn't). So I have a CRT-D implanted, first implant 2007, second 2011, I'm almost due for #3. 46 years old.

When running, doing jump rope, or jumping jacks etc... just like riding a horse, those bumps can count as extra beats and irregular at that. I have learned the hard way. It's a very humbling experience being in a public gym or exercise class and getting a shock.

So HEAL FULLY FIRST... TraceyE has very good advice. Doctors and surgeons tell you things for a reason. Always follow orders. Realize that you can attempt to do everything you did before but not everything is wise, you may want to find alternatives to the jumping exercises.

Thanks

by CyclingDad - 2017-07-12 17:45:59

Thanks to everyone for your helpful and encouraging comments. I can see that it's going to be a long journey, but it's good to hear of other people's experiences, and the need to keep perservering until you get things right. I've been very fortunate with my health up until this point in my life (never been in hospital before, not even born in hospital!), and so it's taking a bit of adjustment for me to get used to being a, erm, patient patient. It turns out my consultant is a keen cyclist, and so we've been comparing notes on particular hills in the Peak District. He just set a particularly fast time for Dead Man's Climb. Just sayin'.

Getting back to normal

by Loupbranché - 2017-07-15 10:41:03

I had a PM on april 2016 because of sinus bradycardia. Since then, I resumed Running and everything got back to normal. Some adjustments may be necessary, for exemple to make sure that the new electric friend is fast reactive enough for the sport you practice. Best of luck!

cycling

by zazen_1 - 2017-07-24 12:31:12

I had to wait about 6 weeks due to swelling in the left arm due to a constriction in blood flow from the wires threaded to the heart via a vein. Cycling - high BPM aggravated the mount of swelling. I also had the low limit reduced from 60 to 50 - my resting pulse rate. The pacemaker went from over 90% to less than 10% pacing. Also had the upper BPM limit eliminated. My chest strap HR monitor does not work well with the pacemaker. When my BPM approaches 80% of my max HR, the chest strap monitor works fine - I'm assuming the pacemaker stops pacing at an 80% or above HR.

You know you're wired when...

You always have something close to your heart.

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