Response rate settings
Hi everyone, I would like an opinion on this. I was in a serious motor scooter accident almost two years ago. 24 days in hospital, right leg broken in four places, brain injury, the list goes on. Eight months later, I passed out while singing in a choir concert. Started seeing a cardiologist and had all tests including electrophysiology, could find nothing. They implanted a loop recorder with hopes to catch something. Four months later, I almost passed out at work 30 min after walking 3.5 miles there. The recorder caught my HR drop from 60 to 30 in 10 seconds and hovered there for 10 min. Then back to normal. Diagnosed with Sick Sinus Syndrome, pacer installed. Originally set at 50 bpm day, 40 night. Two weeks later, check up reported 8% assistance. I talked doc into lowering to 45/35, next report 0.1% assistance. It was pushing when I was at rest unnecessarily. All was ok for about five months. Rode bike to work last November one particular day. Within 10 min arrival I had an episode while sitting and passed out for a few seconds. I asked them to bring BP device. It showed HR at 45. I told them pacer was carrying me and in a few minutes I recovered. Problem was that having just exerted myself plus having been cold, I probably needed 90 or so. The pacer did its job, just not fast enough for the situation. Four months later, I call Medtronic to suggest programming an algorithm to look at 5 min rolling average HR and kick in if it sees plummet, rather than just wait until a minimum setting. Customer rep says, "there is a rate change algorithm in there already, it's just not turned on." I can't understand why I wasn't informed about that capability when installed. Anyway, I see cardiologist in 10 days to implement it. I did a little test of my own a few days ago to see my 'normal' HR drop after exertion. I rode my bicycle to town & back, then up a hill, then stopped, sat down, and recorded HR every 30 seconds for 6 min. It started at 166. The fastest 30 second increment drop was 32. So, when my last June event happened, my HR dropped almost three times faster than my fastest drop normally. So, I would say that if the time window gets set at 5 seconds and the drop rate max is 10 beats in that timeframe, that would easily permit normal conditions but quickly come into play when I have an actual event. It could rev me up to 100 for a minute, then relax and see how I respond. If I fall too quickly, do it again until I stop descending too quickly, then relax. That would carry me through the episode without letting me get near syncope. I'm miffed that I just learned about this feature, but so far I've had only one event, and it was very minor. If my natural HR drop was 5 beats in 5 seconds, and my event rate was 15 beats in 5 seconds, then 10 in 5 seconds should keep the pacer from working when it doesn't need to but definitely when it does need to. Opinions?