MTR (upper limit) Observation

My dreaded MTR! Hoping to have it increased AGAIN at my next appt...

I have been hitting my MTR more frequently now that I have recovered from my AVR. Exercise is getting easier and better. I'm stronger and really beginning to push myself. For me, an MTR of 140 isn't working out, lol..

Anyway, my observation: since my AVR, my MTR episodes have changed. Previously, hitting my MTR would stop me in my tracks! For example, I have been doing mostly cycling which is consistant when on flat roads. But, hit a nice hill and hit an MTR. Before, my MTR would cause me to have to stop and rest with SOB, leg weakness, and a crappy feeling in my gut which would all go away in a few minutes of rest.

NOW, post AVR, I am hitting my MTR, but I can barely feel it. I feel more of a sensation that the device has changed (it feels like the instant they put thingy on to do their interrogation), but I have to confirm it with my heart monitor. It will go from 140-145 down to 80-90 and I just continue on with my workout (unlike before) with a very slight reduction in performance. Moreso, me slowing down to avoid performing at that level as I have no idea if it is harmful.

Just a few observations that make me curious what has changed.

7 Comments

Listen to your body and remember to pace yourself

by Gemita - 2023-07-09 18:15:04

USMC-Pacer, thank you for the update.  You sound as though you are making excellent progress.  My MTR (Maximum Tracking rate) is set at 130 bpm and they won’t raise it higher in case the higher rates trigger my Atrial Fibrillation.

What has changed?  You have got a new valve!

That is quite a big heart rate drop that you are experiencing when you hit your MTR and it sounds to me as though your pacemaker is programmed to do this when your sinus rate gets too high.  Is your pacemaker causing you to go into an artificial 2:1 block?  I think they call it Wenckebach if you ask about it. This could happen if they detected a high atrial rate from an arrhythmia. When this happens, it drops our rate to half. This setting can be turned off I believe or adjusted if that's what it is and providing you haven’t got an arrhythmia like Atrial Fibrillation?  Anyway I note you are hoping they will adjust it at your next check up.

Sometimes a treadmill can answer all these questions, so they can see exactly what is happening as you exercise.  This can save a lot of trial and error getting the settings fine tuned.

Don't push too hard too soon, pace yourself.  We want you to stay well, but really excellent news from you

Settings

by USMC-Pacer - 2023-07-09 18:33:23

Oh it's definitely the settings. They set it lower after my AVR in case of any abnormal rythyms. I don't have AF or anything else except occasional NSVT as mentioned here before. I'll go several interrogations without any, then a few will pop up and be gone again. 

I'm completely used to hitting my MTR, my question was more about the change / result when I hit the MTR. It used to stop me in my tracks, now it doesn't and I can continure with my exercise. 

I have an appt. coming up and I'll ask them what is up... Also, to raise my MTR and remove the 2to1 block. 

I'm guessing they wanted to FORCE me to take it easy while I recover...

Your Aortic Valve seems to be working extremely well

by Gemita - 2023-07-09 19:29:52

With your new Aortic valve this is bound to have improved any fall in your EF and any symptoms of heart failure and you will no doubt have improved blood flow and oxygen levels as a result.  No wonder you feel better as you hit your MTR despite your 2:1 settings block.  

It sounds to me as though you need to be forced to take it easy for a while longer.  It hasn't been that long.  I am amazed that you feel like pushing yourself so early on in your recovery, but it has to be a very good sign that the surgical procedure was a complete success.

Gemita - you are a ray of sunshine and a wealth of knowledge... thanks for that!

by USMC-Pacer - 2023-07-09 19:38:13

You are not the only one that tells me to take it easy. My wife thinks I'm nuts! I've always pushed, pushed, and pushes. But, you are right, I should take it slower :)

I thought about the possible increase in heart function, but I have no idea if it could/would happen that fast. 

We'll find out on the 27th which was supposed to by my 30 day follow-up. A bit late, but the hospitals are swamped in this area. I have bloodwork, ECG, Echo, and talk to the DR on that date. I'll report back as usual.

Thanks for the replies!

We are a family, aren't we

by Gemita - 2023-07-10 03:09:15

USMC-Pacer, Brady, thank you both for your kind words.  We are a family and we all support each other in more ways than we will ever know.  Just by coming here and reporting your success and progress, you have both helped members too.  I hope you continue to do well

MTR

by PacedNRunning - 2023-07-13 02:30:15

When you go in for your appt to raise your MTR, there are 2 ways to prevent 2:1 block.  Either raise your MTR or have them calculate something called TARP. The TARP rate is what determines when you will go into 2:1 block caused by the PM.  Wencebach happens from your MTR to your TARP. So from MTR to TARP you 2:1 block until you hit your 2:1 block.  It's best to have your TARP or 2:1 block rate higher than your MTR that way when you hit your MTR, you don't get pulled down to 80-90 bpm.  My MTR is 185bpm my 2:1 block is 220bpm. I will never reach 220bpm due to CHB but as you can see, It's high enough I won't reach it.  So if raising the rate or they are pushing back on raising the MTR due to your AVR, then make ask to make sure your TARP is higher than your MTR.  If you are 100% paced like me in the RV then you won't ever go over your MTR anyway but at least your rate won't drop in half at your max. You sound like you are doing well. 

 

PacedNRunning

by USMC-Pacer - 2023-07-13 12:18:32

Thanks! Very interesting... I'll definitely work on that. I'm more than satisfied with the results of my AVR and the energy, strength, and motivation it has given me. I'm acturally paced with a bi-ventricle CRT-D. I got the D because at the time my EF was 40-45 and the EP wasn't sure if it would increase, so for "safety" it was implanted. Immediately after my AVR, I had some type of a strange 10 sec rhythm (they didn't tell me what, they claimed it could be because my heart was irritated), but it prompted him to leave the D active. This limits how much they can increase MTR. ?? Maybe you know more about that than I. Anyway, he agreed if that rhythm doesn't reappear, and it hasn't, and my EF increases, which it has, he would turn the D off. That's where I'm at now. By the way I feel compared to before, I'm pretty sure EVERYTHING is improving. My next visit is coming on the 27th. I'm hoping for improvements but it may be too soon. I'll report back as usual. Thanks!

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