Paddling the ICD

Hey all. 

8 months on from having a latest Tech Medtronic ICD put in, recovery seems to have gone quick and most all seems normal.

The question I have is now when walking on level ground, I can, as before, pretty much walk indefinitely. But add in a gentle incline, or stairs, where the pace is the same, but the difficulty of excercise has increased, I find myself quickly out of breath. Such that I need to slow way down, or stop for a quick recovery break. Recovery is quick and I can be on my way, but it happens every time. It seems the motion sense to increase the heart rate, is of course unable to detect any change needing heart rate increase when walking at the same pace, but in a condition requiring more blood flow.

I have heard and read a bit about paddling (tapping) the chest next to (near) the ICD to trick it into speeding up the heart by sensing the tapping.

Does anyone here have any experience with this, or actually do this, and does it seem to help?

Thanks, Mike


Paddling and tapping

by USMC-Pacer - 2024-01-17 22:12:01

I think that was in reference to the older pacers. 

I had the same type of issues as you with increased intensity. It turned out, at least for me, to be with my av delay. They explained it and I'm still confused about it. Anyway av delay would broaden during exercise and my device wasn't quick enough to deal with it for lack of a better way to put it. With my first device, they put me on a treadmill while hooked up to all the monitors and made a few tweaks to the delay.. problem solved. This new device, also a medtronic like yours CRT does it better. But, I still needed some pvarp adjustments. All is well now :)

Hopefully someone will be along that can explain what I just said better than I .. 


by piglet22 - 2024-01-18 07:40:30

I can't speak for your model or your condition, but I can certainly relate to the change in exercise capability.

I've had a pacemaker in for nearly 19 years now and for 18 of those, carried on exactly as normal.

A keen cyclist, not the lycra variety, I could tackle long rides and steep hills.

A year on, the same hills are now a struggle to walk up. Fortunately, there are many shop windows and an excuse to stop and catch my breath.

It's not so much running out of breath but aching legs that stop me.

A quick stop restores function until the next stop.

What I do notice is that my heartrate hardly changes between level walking and steep incline walking, despite being set to rate response. The base rate of 70-BPM might increase to 80 or 85, but nothing over 100 as I might have expected.

What has changed has been the medication that now includes a high dose of betablocker to suppress the ectopics that now interfere with the pacemaker.

I don't know if my lack of capacity is down to the BB directly, or the PM behaving differently.

Just out of interest, I looked up your model and can see that it is quite a new one from Medtronic.

There was a note about a software update. Are you aware of that?


by Tracey_E - 2024-01-18 08:12:10

Have you been back to your doctor to tweak the settings first? Rate response has various sensitivity settings. 

Pacemaker settings for exercise

by Selwyn - 2024-01-18 08:27:57

The rate response ( ie. the ability to change heart rate with exercise) for pacemakers has a number of settings.

I cannot speak for your pacemaker/ICD however for mine I have:

1. Activity threshold ( very low... to very high)

2. Reaction time ( short... to long)

3. Recovery time ( short ... to long)

4. Minute. Volume /response factor.

1-3 are common to most modern PMs.

You also have the option of looking at the upper rate limit, the lower rate limit, and the atrial blanking time ( this can be shortened though is not without risk of feedback).

You need to discuss these settings with your cardiologist physiologist.

In the last 3 weeks I have had my reaction time set to fast - this has made a big difference to my breathing on initiating exercise.  It has taken some years to get this improvement as I always felt that my problems were minor compared to some of the problems people are having. I had some terrible bouts of breathlessness and decided 'enough was enough'.


by Lurker - 2024-01-18 12:04:49

Something you might try before going up stairs is to violently rotate your upper body for a few seconds. This is usually enough to temporarily set the rate response off so you can get up or almost up the stairs.

Used to work for me before my rate response was turned on. 

Doc DX



Great Comments.

by Mike123 - 2024-01-19 05:26:21

Thanks all. A few things to think about and look into.

Getting adjustments is not so easy for me as my area is short of cardiologists so I keep getting bumped from locum to locum. Currently there is not one available so no visit for me until April.

You know you're wired when...

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