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Hi all,

I have had my Medtronic dual lead PM for 11 years and mostly don't need it except when I get long pauses.

A couple of days ago a noticed I'm getting 65BPM pacing continously. Battery due for replacement etc.

My question is, given that I run lots and rarely get paced, now that I'm fully paced till battery gets changed , can i run? and will my own heart rate tke over and limit pacing or will it just pace at 65 with a few extra beats of my own ocurring between paced beats.

Also does the default 65bpm pace my ventrical/atrium or both......thanks team :)

 


4 Comments

pacing

by Tracey_E - 2017-11-25 08:00:37

If your rate is a constant 65, I'm going to go out on a limb and say you are pacing more than occasionally. The heart can go as fast as it wants, the pacer is only a gas pedal, not a brake pedal. Normally activity would be limited during this stage, but if you truly are only pacing through pauses you should be fine because whatever mode it's in, the pacer won't let you get below 60 or 65 bpm so no pauses.

Try a run, see how you feel, see if your rate gets up as it should. If it goes up and you feel good, go for it. If it stays too low, if you don't feel strong, then don't push it until after the replacement. 

what i mean is…

by lynxptcomau - 2017-11-25 18:16:39

Thanks Tracey,

I know that my pacemaker has 90 days left because its now pacing me at 100% at 65 bpm, thats a default setting when pacemakers batteries are almost expired.

 

Normally I am paced less than 1% so is all this extra unnecessary pacing going to cause problems if I do some moderate exersize and say lift my heart rate to 140 ish.. thanks Pete

end of battery life

by Tracey_E - 2017-11-25 23:31:15

Your heart can still go to 140, the pacer can't slow it down if it goes that fast on its own. 

EOS Pacing and Exercise

by Hoosier Daddy - 2017-11-26 01:06:04

TraceyE has it correct.

An interesting setting is when a pacemaker is placed into asynchronous mode such as when a magnet is applied to the "can". I've done this with my patients' devices for decades, and there has been a huge debate in my specialty about the proper contexts for magnet application, but as devices have evolved they have become more universal in their behavior under a magnet so the controversy among people who do what I do has become less intense. 

The interesting thing is that when we magnet a device, it goes asynchronous - often at 85 - and that leaves my patients vulnerable to the phenomenon of "R on T", where the pacemaker can theoretically deliver a pulse on top of the heart's own rhythm at a dangerous moment and actually induce VF. But in my workplace, I'm staring at the patient's ECG continuously so even if that happened, we treat it within seconds.

Most pacemakers remain in a DDD mode, likely without rate responsiveness, when they enter End of Service / Safe mode. As such, they simply fix their rate - typically at 65 - but they are not asynchronous, that is, their sensing continues so they will not fire an R on a T wave. 

Your device may not be able to accelerate to meet your metabolic demands, but it should not be doing anything "dangerous" in End of Service mode.

Regarding whether it is pacing your atrium, your ventricle or both during EoS mode, it is doing whatever it has been doing, most likely in the DDD mode - some combination of AS-VS, AS-VP, AP-VS and AP-VP. The only difference is that the rate is fixed at 65.

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