Can anybody explain this to me

So I have Pacer for bradycardia setting are set at 60/165 now when I was exercising before I got my hr max to 148  t fairly quickly according to my rythm+ heart rate band and in the middle of my walk it did not get a reading at all then when I stopped and started slowly walking it was reading my hr was in the low 50s and low 60s I think I got worried a little.

I also have a question on pacing with a Pacer and exercise do they make your heart rate go up quicker then if your natural conduction system would or will conditioning help in that regaurd to make it not spike so quickly. 


Probably not

by AgentX86 - 2019-07-15 23:22:43

First and formost, you cannot trust a wrist device to give you an accurate pulse rate.  You really have to count it manually.  These devices are easily fooled, particularly during exercise.  As a test, when you think your heart rate is leveled out at a fairly high rate, take off the watch (while still exercising) and put it back on.  Now see what it reports. 

If your settings are as you say, your pacemaker shouldn't let your heart rate go below 60bpm but you can't trust the measurement.  Count it yourself. 

It's similar to a chest strap

by benne81 - 2019-07-16 00:06:39

Similar to a chest strap not wrist based so it's more accurate. Anyways I didn't really manually count but I kind of felt the pulse by my neck I should manually count next time but it definitely was not where it was at and was lower then 100.If anything it will show up at my next office visit. I just wonder as my conduction system was altered from heart surgery itself and that originally it came back after lots of exercise and after recovery.  but then I went back to being Pacer dependent a month or so after that

Not enough information to answer your questions

by crustyg - 2019-07-16 04:58:18

Hi: Yes your PM could easily drive your HR up more quickly than you would naturally - rate response is controlled by a number of settings which affect this.

Chest straps usually give a fairly reliable heart rate - they are after all using the exact same technology as a Holter 24hr ECG/EKG recorder - except that a chest strap is only showing Lead I.  Wrist devices are usually pulse-oximeters which perform poorly during exercise, so their claimed HR is not so good.

I lost confidence in my chest strap HR some years ago when it kept failing to show a HR during exercise - foolish me.  What my strap was telling me was that I was having episodes of tachycardia where it couldn't decode the heart beat from the other electrical signals it was receiving - lesson learnt.

You don't say if you're single-chamber or dual-chamber paced.  If the latter, then your A-V conduction won't stop your PM from driving your heart.  If the former and you have some A-V conduction issues (which may come and go) then, yes, your PM might not be able to pace you properly.  Seems unlikely that your EP physician will have left you in this condition, but as ever, when worried, ask your clinical care team.  At the very least get someone to interrogate your PM - it will have recorded things that it's been asked to - like loss of pacing capture.


by Tracey_E - 2019-07-16 10:14:11

No matter how good the chest strap or wrist monitor is, the pacer can mess with it. The pacer can interfere so it misses beats so it shows too low, or it can pick up the pacing spikes as well as the beats and shows too high. Never trust it. My apple watch is pretty accurate. I've had high end chest straps that read 0 no matter what I did. The finger thingy on my phone always shows well over 200. Count manually. However, if you are walking or otherwise exercising, and you feel good, don't bother! Trust that whatever your rate is, it's good.

They should be able to tell you if you are pacing or not when your rate jumps up quickly. If it's atrial pacing then that's rate response and it can be adjusted to be less sensitive. If you aren't pacing or it's ventricular, then it's all you. Ventricular pacing means your sinus rate is ok but the pacer is making sure the ventricles stay in sync. Either way, the pacer is only a gas pedal, not a brake so if you are going faster on your own there isn't anything the pacer can do but watch.

Me, I like mine to be set to jump up quickly. It's a little annoying when I get breathless walking up the stairs, but it's great at the gym. My own personal my turbo charge. 

If your minimum is 60, sometimes your rate will count in the 50's and that's ok. There can be little half beats we don't feel to count, and 60 doesnt mean 60 beats per minute, it means 1 beat per second. It will not let your heart go a second without a beat. Over the course of a minute, that will work out to close to 60 but not always exactly. 

If you feel good, try to resist the urge to count often and overthink things. Trust the pacer to do its job. 


by Sgtsemperfi - 2019-07-16 12:34:41

I am new at this game but I would like to congratulate each and everyone of you for responding to our various concerns. We, newbes, feel like we were left in a closet. Zero info leaves us, initially, in a state of stress, etc; slowly, we learn that we must become aggressive seeking out our answers.   Each time we do we receive another shot of confidence. So, once again, thanks for your patience in dealing with us. God Bless.  Old jarhead

Also Responses

by Marybird - 2019-07-16 13:50:03

I also wanted to add my two cents to the thanks and kudoes to the pacer/ICD veterans for their responses and the great information to us newbies in this "pacer" world. 

Tracey, your explanations and your own experiences with your  wrist monitors (as well as everything else) are very helpful to this newbie, who's still wandering around wondering "what the heck" sometimes, a month and change after my pacemaker was implanted. 

I'm doing well, things are healing well, and I'm back to normal activity- past being paranoid about yanking the leads out by lifting my left arm over my head, LOL. I had been wearing a Garmin watch and used it to monitor my heart rate for the last two years (with some help from a blood pressure machine, pulse oximeter and even manually when I didn't believe some of those bizarre results). But after the pacer I decided I didn't need a blow by blow heart-rate, didn't care what it was as I was assured the HR would not go below 60, and if I had tachycardia episodes, they'd be recorded by the pacer, and if they were significant, my doc would be  alerted and they'd let me know. So, I thanked the Garmin for it's service, and put it aside (other than keeping it charged, and switched to a regular (pretty) watch. 

I check the HR with a pulse ox, and decided I'd wear the Garmin a couple times if for no other reason than the joy of seeing the HR always at 60 or more. Sometimes they both read in the 50's for a short time-but go back to 60, and from your explanations (as I'd figured as well), realize this is just variation between various measuring devices. But I've also seen  on severals occasion, with both the Garmin and the pulse ox, HR readings that go into the 40's and even into the high 30's for as long as maybe 10-15 seconds, but then they climb back up into the 60's and we're good to go. 

I'm thinking those very low readings are probably associated with the PVC's, or other wonky things that sometimes go on with my heart, or maybe they're just hiccups. And I suspect I may also be having some tachycardia-sometimes feel some flutters, but not long, or bad, but my Garmin watch will show HR readings that climb up into the 130's-150 ranges. I have atrial tachycardia (tachy-brady) so it wouldn't be a great surprise though I'd hoped I was taking enough medication to keep it under better control. 

I figure I'll know soon enough whether these readings, are real, or just figaments of my imagination. I go back to fhe EP and pacer clinic tomorrow and imagine I'll get the lowdowns of what's happening.  All in all, though, things are looking up, I'd say.

Thanks again, Mary




I don't recall I think I have two leads

by benne81 - 2019-07-16 19:34:26

From my understanding is that my heart is diong the work but the Pacer is needed to get the information across because of the surgically altered conduction system even though it's strange how I went from chb in April to having my Pacer set as a backup at the end of August that same year after I had my valve repair surgery back to being Pacer dependent shortly after that. I wonder if exercise has anything to do with it.

I don't know if this is a coincidence but today the day after in the morning maybe twice I felt slightly off but it was not lightheadedness and only lasted a couple seconds. I am going to keep on gradually increasing my exercise and report back to my ep in September. Maybe I got my rate over the limit for a few seconds I doubt it though.

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As for my pacemaker (almost 7 years old) I like to think of it in the terms of the old Timex commercial - takes a licking and keeps on ticking.