What are the various settings and what do they mean


I received my PM in December 2018 due to a rapid onset Left Bundle Branch block. I was previously running or hiking every day. I have gone back to those activities but still think I am not back to my previous performance levels. I have had three adjustments so far and the last was the best. However neither the Clinic Nurse nor my Dr. has been willing to give me an explanation of the adjustments they made or what effect they have.


Heart rate. Initially it was set at 50-130 and after two complaint sessons they increased the max to 140. (I am 76 ). Last time I asked what the limit meant and was told," it is really too complex to put into words". I know I go over 140 when running and hiking up steep hills . Can anyone explain the advantages/disadvantages of increasing that rate?


Slope. I think that adjustment is to guide the rate of heart rate increase in response to increasing my level of exertion. However that may not be it at all. Can anyone explain? I do know they adjusted the SLOPE on my last two visits. I was much worse after the first and much better after the second.


Lastly. Are there other PM adjustments that can be made? I have an Abbott PM2172(St. Jude Medical) 




Rate Responsive

by doublehorn48 - 2019-06-11 23:52:33

When I google slope I see that we now have a rate responsive pm that's an alternative to a dual chamber pm.  It seems that they need to keep adjusting your pm, if in fact this is your type of pm.  At 76 your max heart rate is 140.

My dual chamber pm is set at 60 to 160.  At 70 my max is 150, but I had a stress test today and hit 152.

I would keep going back for adjustments.

can take a while

by dwelch - 2019-06-14 01:27:49

I was a VERY active 19 year old when I got my first pacer....30+ years ago (the tech was not remotely as good as today) it took a number of visits over that first year or so before we stopped tweaking it...the pacers are better today but I would keep going back and see if they can continue to tweak it, wear a halter for a day or so and do the activities you want to return to with the holter on, make notes of the time when you perform certain activities on the notpad and they can then see what the device is doing or not during those periods.  

It depends in part how engaged your doc or practice is as to how hard they will work on this. Keeping you alive is job number one.  Allowing you to return to activities you want to do vs need to do is secondary.

its a gamble if you like them otherwise but if they dont seem engaged enough then you might want to find a different doc/practice.  hard to tell if the grass is going to be greener or not on the other side of the fence.

Settings and straight talk

by Gotrhythm - 2019-06-15 20:25:26

"Too complex to put into words"--pooh!

Sure there are all kinds of fancy algorithms involved but when you boil it down, a pacemaker only does one thing. It makes the heart go faster.

The upper limit is simply the fastest heartrate your pacemaker will go to. It's possible that your heart, on it's own, can go faster and if it can, the pacemaker will let it. The lower limit is the lowest your heartrate can fall before the pacemaker starts to add beats.

Your understanding of slope is correct. It's all about how fast or how gradually the rate response function will increase the heartrate in response to increased activity.

About adjustments and explanations---here's something they're not going to tell you: It's all guesswork, trial and error. And not because they don't know their business. The fact is every heart is different, and every personality is different. Sure, the professionals know how to change the "slope," and they can make an educated about the effect it will have, but they cannot predict whether a patient will be happy with it.

Yes there are other settings. Some pacemakers have a sleep setting--to allow your heart rate to fall when you sleep. And there are other settings having to do with the timing between contrractions of the upper chambers and lower chambers. Probably some settings I don't know about. 



by watchowardrun - 2019-06-16 15:02:21

Thanks very much for your comments. I will use your information at my checkup tomorrow. 

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I am 100% pacemaker dependant and have been all my life. I try not to think about how a little metal box keeps me alive - it would drive me crazy. So I lead a very active life.