MEDTRONIC EXCERCISE SETTINGS

• by frankmcw2
• 2018-04-18 15:54:36
• Exercise & Sports
• 2788 views
• 4 comments

I previously posted a question here asking for suggestions to better adjust my ADVISA pacemaker for different forms of exercise, (see below March 3rd). I received some excellent responses that I was able to communicate to my cardiologist. I should say that I actually was able to find two very knowledgeable Medtronic technicians who were able to make changes to the settings of my pacemaker that have resulted in much better response to all my forms of exercise.

I have SSS, Chronotropic Incompetence, and AV Block, or in other words my sinus node does not function well enough to elevate my heart rate consistently for excercise. Since the Medtronic pacemakers only respond to movement through an "accelerometer" the upper body (where the pacemaker is implanted) must be jogged about significantly to produce a response. Therefore, the pacemaker was doing just fine for jogging, consistently elevating my heart rate to about 144 bpm during runs. However, when bicycling, mountain climbing, gym excercising, climbing flights of stairs, or even just walking about the house, my heart rate was never high enough to do the job.

I will try to explain the new settings to my pacemaker without getting too technical. But if you are due for a meeting with your cardiologist or (much better) your Medtronic technician, have him show you the "tri-phasic curve" that the pacemaker bases its decisions on. He will show you right on the screen as he runs the interrogation.

To begin with, my ADL rate was set up to 115 bpm two years ago. This setting is up from 95 bpm which is the level most new Medtronics are set to. This was done to make the pacemaker respond more aggressively in elevating my heart rate for "Average Daily Living". The problem has been that my average daily living activities were not physically strong enough (not jogging around enough) to make the pacemaker elevate my heart rate to the 115 bpm. So I was always out of breath at the top of a flight of stairs, among other things.

So my recent adjustment was to change the "ADL Response" from the factory setting of 3 to the max setting of 5. This worked immediatly, with just normal walking, stair climbing, etc. resulting in my heart easily elevating to 115 bpm. This is enough for me to do just about anything short of running without losing my breath. I am now able to bike up steep hills, climb aggressively up steep trails, swim laps, and move about the house with the fully oxygenated blood my heart is now providing. Also, my jogging heart rate has not been affected, and still works fine at about 144 bpm or more. So, the "ADL Response" change did not change the pacemakers response to jogging. Another thing that has occured is that when bicycling and climbing my heart is not just elevating to 115 bpm but is going higher into the 130+ area. According to the Medtronic technician, this is being manufactured by my sinus node and not the pacemaker. I believe it is because the pacemaker is creating a platform of 115 bpm, which makes it easier for my sinus node to achieve a higher rate on its own. The only adverse thing I can say is that my pacemaker is now pacing more often, but it is not actually very noticeable except when I first sit down or recline for bed. Perhaps this will result in reduced battery life, but that is the price to pay for an improved life.

Next, and this is going to get a little more technical, I had another setting change three weeks later from a Medtronic technician who has been working with bicyclists trying to find better adjustment settings. He turned the Rate Response "Optimization" setting to OFF, and at the same time set the "ADL Setpoint" to 10, and the "UR Setpoint" to 120. Turning the "Optimization" to OFF takes away the "ADL Response" and "Exertion Response" settings. So, now the counts of accelerative movement that the pacemaker senses are 10 to get my heart to the ADL rate of 115, and 120 to get my heart up to as high as 160 bpm. If the "Optimization" feature is ON the pacemaker will be reprogramming itself daily, continually changing the ADL and UR setpoints. In the case of someone who excercises a lot it will reprogram the numbers higher and higher until you will no longer be able to get the counts that are necessary to elevate your heart rate. (Prior to these recent adjustments my "ADL" setpoint was at 44 which would make it difficult to achieve that much movement to get my heart rate to 115 bpm.) It seems to me that the "Optimization" feature of the pacemaker must be designed for more sedentary people, and perhaps it has its advantages there. But for someone trying to excercise consistantly it would seem to always present this problem. To be clear, turning the Rate Response "Optimization" to OFF and setting the numbers lower, is exactly the same thing as changing the "ADL and Exertion Response" settings to a higher number. Your Metronic technician can show you on the screen of the computer he uses to read and set your pacemaker.

I hope this will help some of you, and I will answer any questions through comments to this post.