Exercise & Rate Response

Hello, had my pacemaker replaced in January of this year (27F, 3rd degree heart block, based in UK), got a Boston Scientific one, had the rate response adjusted but still feel like I am getting out of breath when walking (not only on hills just out in general if trying to go fast), trying to do spin classes at the gym. I am going to see my tech next week to see if I can get some adjustments but not sure what I should ask for, am I wanting  them to increase the rate response? I also have minute ventilation turned on too.

I have had a pacemaker my whole life but due to complications for last 20 years had my pacemakers placed epicardially in my abdomen and never had this issue with exercise (even waking upstairs/hills I was ok usually) I think cause of the location it was easier to sense the movement which was great but back to the “normal" location now in shoulder. 
This won’t happen but I think the manufacturers/doctors/techs need to re-think if placing the devices in the shoulder area is really the best place, since as we all know most rely on movement to start to increase the rate but with a lot of exercises and daily activities you might not need to move your upper body much so the device doesn’t respond well. When pacemakers we’re first introduced it was mostly for older people who probably were very sedentary and didn’t notice the rate response but many younger and active people need them now and want to continue their sports and exercises, frustrating sometimes ☹️😋

3 Comments

Exercise and Rate Response

by Gemita - 2023-10-21 10:42:08

KMCG2, what is important is that you describe your symptoms to your doctors just like you are describing them to us, rather than going in with a list of settings you think might need changing.  

Most of us have problems with Rate Response features across several manufacturers and this seems to be the setting that is difficult to get right.  You could ask for treadmill testing while they adjust your settings, so that they can see for themselves the difficulties you have while exercising.

Since you have strong views and you know your exercise requirements, I think it is important that you tell your doctors exactly what you want to achieve with your pacemaker.  They can then adjust your settings accordingly.  From your comments, it would appear that Rate Response is the setting that needs optimising.  Your technicians will know what settings were last adjusted and can work further with these to make them more, or less, sensitive.  I would also spend time optimising Minute Ventilation and ask whether Rate Response feature works well with Minute Ventilation and/or whether both features need adjusting?  You might need a Boston Scientific representative to be present since they will know their own product best. This would give you the best chance of getting your settings working well for you.

I have had problems getting my Medtronic Rate Response settings adjusted.  For the moment my Rate Response has been turned off but clearly this is not the answer either.  By the way, I am an "active" older person.

Good luck.  I am sure your doctors will be able to help you.  You have got a good pacemaker for exercise, but it needs an experienced technician to get those settings working well for you. 

Settings for exercise

by elcarim - 2023-10-21 23:59:26

I had issues with the settings during exercise when I first got my PM at 27yo. It came to a head when I nearly passed out during a round of showjumping!

I mentioned it at my next PM check and the consultant arranged to put me on the treadmill and hook me up to monitors to see what was going on.They were able to adjust my settings to be more appropriate for me during exercise.

I have one sided heart block from surgery, so I set my own rate up to a point. Rate response can have its own drawbacks. I asked to have mine turned off because every time I used my ride-on lawnmower over my vast, bumpy lawn the PM would think I was running and increase my heart rate. My PM is in my upper chest.

So as Gemita said, describe your symptoms at your next PM check (mine are usually with a cardiologist and a Medtronic rep) and see what they can do for you. It might take a couple of follow-ups to dial in, but going forward this can set the blueprint for setting your future devices. Good luck :)

CCHB and Rate Response?

by crustyg - 2023-10-22 04:09:20

Your bio says paced since 3months old, so CCHB.  Usually CCHB patients have a normal, working SA-node, so the PM transfers the impulses from RA to RV, and the SA-node responds to the body's demands (and the sympathetic nervous system).

It *sounds* as though your SA-node isn't working correctly ('had a couple of complications'), and you might need RR.  In that case you need your RR tuned for your lifestyle - which takes a few tweaks and a willingness to keep adjusting your PM settings until you get the best that you can for your preferred lifestyle.

You don't mention your BostonSci PM device model, but it *probably* supports MV.  Someone posted here recently that their PM centre never uses MV except for road cyclists.  Still stuck in the 1950s, sadly.  It's also good for swimming and walking up hills.  The wonderful BostonSci rep that my EP-team sometimes call in pointed out that the accelerometer on Accolade is set for forward/backward movement - and there's only one.  The different placement in you might account for the changed experience of the accelerometer feeding into your RR.  Some of the leadless PMs have three accelerometers so will respond to movement in any direction - the older devices could be updated to have more but that costs serious money.  MV is a *lot* more useful than some people think, but you do have to understand and tune it - which takes time and effort.

As an additional note, it seems likely that UK NICE will soon approve closed-loop glucose-sensor/smartphone-app/insulin pump systems for the most 'deserving' type-I diabetes patients.  Given that the smartphone app can be told to factor in upcoming exercise, this will deliver patient-controlled device-management.  Gasp!  A step closer to the holy grail of patient-controlled PM device management (but different docs with a different mindset).

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