Exercise and rate response.

I received my PM in April this year and still getting used to it. It was implanted for bradycardia and Afib. I’ve had several adjustments to make the rate response less sensitive and a lower target heart rate. For a while I was feeling awful when riding in a bumpy car/boat or just taking a flight of stairs. That has pretty much subsided, once they lowered the sensitivity (I think it’s set as low as it will go) and set the upper max rate to 120, any higher is up to my natural signal.

My problem now is fatigue, short of breath, excess sweating, and dizzy when I exercise (I play in a table tennis club, I’m 58). Seems like after a couple of matches, I’m spent. Is it the meds? 100 mg Flecanide, 25 mg metoprolol 2X day. 

Anyone else been through something similar?




Rate response

by AgentX86 - 2019-08-22 22:38:15

Most of us have the opposite problem - we cant get rate response, responsive enough. But...  do I understand you correctly, that your natural rate response is still functional?  You're not cronotropically incopetent?  If true, perhaps you don't need rate response at all.  You need a pacemaker as a floor so you don't suffer from the effects of bradycardia but perhaps you don't need any control above that.

It's not clear to me what you mean by saying that you go your pacemaker for bradycardia (that part is obvious) and afib. What is it doing for your AF?

Not enough info...

by crustyg - 2019-08-23 09:34:22

I echo AgentX86's comments.  Many folk here with a PM and bradycardia can't get their HR up in an appropriate fashion (quickly enough in response to need for extra heart output, or to a high enough HR, or both - chronotropic incompetence), but some have a degree of natural HR response - I do, but only to a certain level.

But your symptoms also fit nicely into the known sideffects of your drugs.

You haven't provided enough information for us to help, I fear.

Time to go back to your doc!

More info

by John K - 2019-08-23 12:24:21

Sorry if I was confusing, but seems like I'm that way alot anymore. My PM was implanted to take care of my bradycardia (I was normally upper 40's low 50's at rest, an was masured as low as 31 while asleep with Zio Patch) so as to allow me to take the anti arrythmia drugs for the Afib.My low rate is set to 70 now. 

I'm still suffering from episodes of AF, and now my Doc is talking about an ablation. Ugh



by AgentX86 - 2019-08-23 13:07:24

Yes, that's more clear. A PM will do nothing for Afib. An ablation might and your odds are far better with a really good EP.  This is huge.

Don't sweat an ablation. They're a piece of cake. If it'll fix your Afib, you should be standing in line waiting for the doors to open.  But, you want the best EP possible.

Max rate/timing issues

by Elisabet - 2019-08-23 17:54:22

Something else to consider, although it might not apply to your setup. 

I was having issues with "crashing" everytime I tried to exercise moderately. I'd be feeling feel great for a few minutes and then I'd just run out of steam like I'd been going an hour. It turned out that if my heart rate was close to the set max rate, the pacemaker would cause me to go into bigeminy, trigeminy, x-geminy... basically dropping to half, or two-thirds or three-forths etc. 

Since I have complete heart block, the pacemaker just bridges my AV node and the pulse rate is generally set by my own body. But, if I was close to the max rate, my atrium would fire but the pacemaker would ignore that input because it was too soon after my previous beat. Then the pacemaker would pick up the next one, and so on. Effectively my upper and lower chambers would get slightly out of sync.The effect would be similar to playing two musical notes very close in pitch together and hearing the "beats". 

The EP raised the max rate and tweaked some other settings and that made a world of difference. Before that, it wasn't that I was topping out at 130, it was that I would go 128, 129, 130, 130, 130, 65. Sometimes it would drop by half, sometimes just by a third or a quarter, but in any case my effective rate would drop precipitously, making me "hit the wall", just as I was getting going. 

ETA: The culprit was probably it being left in the default settings, which didn't matter when it was put in, since I needed it less than 1% of the time. That had changed by the time it was discovered when I ended up in the ER with a brain hemmorrhage, which happened shortly before I would have had my regular pacemaker followup. Anyway it was awhile before I could complain about exercise intolerance being an issue. 

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I, too, am feeling tons better since my implant.