What is PVARP
I just joined Pacemaker Club and this is my first post. I’m hoping someone will be able to give me a layman’s overview of PVARP. I’m trying to get a basic understanding of it in an attempt to get my pacemaker settings properly adjusted. The “pacer” says her hands are tied by PVARP and cannot make the changes I’m asking for.
A bit of history: I’m a 62 yr old male and I’ve been very active most of my life until a number of years ago when I suddenly could no longer exert myself without feeling wiped out and exhausted. I’ve run more than 100 miles in a week, a 2:49 marathon, days when I ran 3 times, biked twice and threw in a bit of basketball in between, then all of a sudden mowing lawn was an effort. In September of 2018 I was given a pacemaker (Boston Scientific L311 Accolade MRI) because of an AV block cutting my pulse to about 50%. My resting heart rate could drop below 30 but I never had symptoms other when trying to exert myself. When I was very active my resting heart rate was low 40’s.
Now my dilemma: As far as I know the Sinoatrial (SA) node is functioning properly so I thought the pacemaker would follow the SA node and fill in the missing beats, increasing my heart rate as driven by the SA node. But I still cannot exercise much. I’ll go for a 4 mile fast paced walk in the hills and my Garmin watch HR monitor is indicating upto 140 bpm. When I try to run I only get about a half mile before having to walk again. The HR monitor is locked in at 140bpm, just what the upper limit of my PM is set at. I’ve tried to get the “pacer” to increase the upper limit but she says that the PVARP will not allow it.
She has the PM setup with “blended response” which uses the accelerometer and respiratory sensors. Since my SA node is working fine I do not see a need to have any type of rate response and feel that is just complicating things. I have not been able to find out the max heart rate designed into the Accolade. I’ve been trying for months to be given an exercise test to see what the PM and SA node are doing but got nowhere until I said I would have to find someplace more accustomed to active people with pacemakers. I still do not have a commitment for the stress test but I’m hopeful.
Any ideas? Is the PVARP issue always a problem or is it related to having the rate response turned on? A max of 140 bpm seems like a low number to me. Of course the “pacer” is stuck on the 220-age guideline and has repeatedly told me she doesn’t have the time to teach me about PVARP.