Rate response

At my 6 week check my PM was lowered to 70bpm, and also my rate response, after I demonstrated that touching my toes 5 times resulted in a very fast pulse.   Now, for other reasons my base rate has been raised back up to 80 for the time being, and I am having this very fast pulse when I do hardly anything.  Does the rate response have to be tweaked every time the base rate is changed?  


8 Comments

Time to start asking for a copy of your settings at each visit....

by crustyg - 2019-07-16 17:56:53

Hi Theresa52: No, there's no requirement for rate response to be linked to your lower rate limit (LRL).  The two can be programmed independently.

It doesn't *sound* as though there's been a lot of communication to you about why your settings have been changed - and it's up to you to change that.

Start asking questions, explain that the new settings make you feel unwell, or odd, and keep gently pushing for proper explanations about what they are doing and planning to change.  Ask for *ALL* jargon to be explained.  If it takes them a little longer, that's not your problem.  You aren't a sausage in a factory.  Prepare lists of questions and don't leave until you've got answers.

Once they understand that *you* understand - and what they've done is making things worse, a good EP and tech will share more with you and pay you the respect that it's your body they are tinkering with.  If they don't then change them.

It's that simple.

But intelligent questions first, give them a chance to share and work *with* you before pressing the Eject button.

Rate response

by Theresa52 - 2019-07-17 04:06:18

Thank you - the base rate was raised because I had problems with ectopics and a run of VT.  As I had been okay at 80, it was decided to try that again.  

Rate Response

by Selwyn - 2019-07-17 06:00:59

You may want to consider having a slower onset of rate response. The onset speed ( and off set) can be changed independently of the actually upper and lower limits. 

If you are not a 'race-horse', perhaps a slower onset would stop the tachycardia problem after a few toe touches.?  Personally, I find my rapid onset rate response is a bit slow for going off at top speed for swimming ( especially in cold water). I am thinking that when I need a new PM I will ask for one with a minute volume rate response, as well as the accelerometer, in that way I may also improve my ability to run up stairs and dance the Viennese Walz ( where the accelerometer is not activated as the arms are held in the same position) !

 

Rate response

by Theresa52 - 2019-07-17 08:27:53

Thanks Selwyn - Do you know I cannot imagine being secure enough with this pacemaker to ever go swimming, and I think you are amazing to swim in cold water!!

RR and you

by Gotrhythm - 2019-07-17 16:06:48

Frome reading posts here, I've come to the conclusion that getting reponse rate right is totally an individual preference kind of thing.

Finally, after discussing with my EP how I wanted to feel, and what my physical goals were, my EP set the response rate very fast. I love it. I can go from a stand still to dancing fast without any sense of "drag," without any momentary breathlessness.  There's no need to slow down taking the stairs. All my life I've been the kind of person that when someone yelled "let's go." I was up and out the door, while others were still getting off the couch.

Of course, my HR can jump to the high 80's just because I reach for a kleenex--but so what? Feeling my heart speed up momentarily doesn't bother me.

But let's say, you've always liked to take your time getting off the couch. There isn't any "correct" RR. Keep talking to your EP until you get the one that's right for you.

Oh, and what does being secure with your pacemaker have to do with swimming?

 

Rate response

by Theresa52 - 2019-07-17 18:05:41

I think I associate swimming with fitness and at the moment I feel anything but fit.  I had 20 years of increasingly disabling AF episodes which meant I was afraid to go far from a hospital.  So, I had the pacemaker and AV node ablation as a last resort.   

The initial few weeks went well and I felt like a new person, but then came ectopics fast and furious, ending in a horrendous VT attack one night where I very nearly passed out.  

Now we are trying to find that precarious balance between meds and rate response to keep me on an even keel.  So .........definitely no swimming!!

PM tuning - personal and essential for most/all of us

by crustyg - 2019-07-19 09:56:57

Hi: I would echo Gotrhythm's point that PM tuning is very personal - getting the rate response right for you, your heart and your lifestyle is key and the settings are unlikely to be like anyone else's.

I would encourage *everyone* who feels dissatisfied with how well/quickly their PM raises their HR to charm/bully/pay for a PM tuning session, using an environment that as nearly as possible simulates what you want to do (I think the swimming one is the most difficult).

For me, it's time on static bike, to tune the breathing input from a steady upper-body into a drive to increase HR, for the dancers it could be a corridor outside the room with the programmer (my PM can talk to the programming and viewing system from 50 feet away - yours may be able to as well), for the runners it's a treadmill, etc.

This thing that helps you - or keeps you alive - is personal to you, your body, your lifestyle and your aims.  Why wouldn't you want it optimised to the very best it can be!

Best wishes.

Rate response

by atiras - 2019-07-20 14:35:48

I had a PM fitted and AV node ablation last autumn, and had problems almost from the off withrate response...

I'm by no means fit or athletic (that'd be a joke)  but just walking a few yards made me out of breath (as the device techs noted when I went to visit them earlier this year: "I could hear her puffing as she walked along the corridor".)

They upped the rate response and reduced the base rate and I've been much better since, even when they reduced the rate again to 60 -- I insisted they kept the rate response so that the upper limit didn't reduce . I still have problems but I suspect they're heart-muscle-related not PM-setting-related).

Bottom line: insist they keep trying until you're comfortable -- if they tweak the base rate, but your upper rate suits you, insist they tweak the rate response as well to keep that upper level OK.

 

 

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