Non response from pacemaker during exercise

I ride quite a lot. All too frequently I experience the situation where my pacemaker simply doesn'y respond during effort. I can be riding and my heart rate won't budge from low to high 80's even if riding uphill. This can last for an hour or more and then spontaneously move to a more appropriate rate. Even riding on flat roads is a chore and unpleasant.

I've discussed this with my cardiologist and the Biotronik technician and invariably their response is to try and adjust the settings to be more aggressive. Inevitably this makes no difference. I've had my current dual lead pacemaker in place for nearly 3 years, so it's not an initial setting thing.

My queries are severalfold: is it a connectivity issue; is the pacemaker fit for purpose or faulty; do I have some other underlying cardiac issue; maybe something else. I'm not on beta blockers or similar so that can't be a factor.

Anybody else have/had similar issues and what has been done to resolve it please? I'm 75 and enjoy being active. Walking is generally fine, but going up steps or the like can cause shortness of breath.


8 Comments

"Inevitably this makes no difference"

by crustyg - 2024-01-28 03:13:44

Something is wrong if you're so sure that adjusting Rate Response settings is a waste of time.

Either you don't have any form of RR enabled, or your team isn't adjusting the correct settings - or just possibly, your PM is 'defective'.  I'd put that last option waaaay down the list.

Quickest way to resolve this: ask your EP-team to set up a treadmill or static bike session and show them the lack of increased HR.

I can think of at least one cardiac issue that might be in play here: as soon as your RA rate increases, you move into heart block - perhaps 2:1, so your ventricular rate doesn't appear to increase.

A final option would be a Holter monitor for a few days, and then do some exercise with it.

Response

by piglet22 - 2024-01-28 05:20:01

Does sound unusual.

As crusty says, a Holter would go a long way to finding out what's going on as would treadmill for.a few minutes in clinic with ECG.

I didn't note your location, but in the UK, this sort of investigation can take a very long time to organise through the NHS.

I appear to have developed the same poor response to exercise. My HR won't budge over 80 BPM.

It pretty much brings me to a halt walking up hills which I used to cycle up 18 months ago.

However beta blockers are the likely reason (10 mg Bisoprolol daily).

I'm seeing the consultant in a month but the promised Holter hasn't happened.

I'll certainly be raising it. If there is an answer, I'll post it 

My issues..

by USMC-Pacer - 2024-01-28 15:03:36

My issues through both of my devices was the max tracking rate = easy fix. I had another issue with my first device - a two lead like yours. They couldn't get my exercise to where I felt normal. Finally, long story short, they did what was mentioned above, they put me on a treadmill monitored and saw that my AV delay got more broad as I exercised which prevented proper ventricle timing and would keep me in 2:1 block. That was my old device. With the new device, the same type of issue, but this time they adjusted my PVARP settings and all was well. Anyway, I'd request a treadmill eval. to see what's happening as said above. 

Non response from pacemaker during exercise

by Paul3199 - 2024-01-28 21:35:28

Thanks all, your comments are helpful. A holter monitor is on the agenda and that may help. A treadmill or exercise bike is hit or miss because of the eratic nature of the problem. For example went for a ride this morning, the first 35 kms was rubbish with heart rate stuck under 90 bpm. Stopped for coffee, back to bike and straight off at 130 - 160 bpm for the remaining 30 kms. Nuts. I'm in Melbourne, Australia so we're well serviced medically.

Definitely ask for a 3day Holter

by crustyg - 2024-01-29 03:51:38

It does sound as though the approach with the maximum chance of showing your EP-team what's going on is a multiple-day Holter with you exercising.

Intermittent HB is my bet.

Best wishes.

Response

by piglet22 - 2024-01-29 05:11:19

With your intermittent problem, you need to take every opportunity to get medics to appreciate that something is going on, and that can be hard work.

Holtter or treadmill are those opportunities.

Having said that, a five day Holter didn't pick up my troubles, not helped by worn out batteries being fitted and having to be changed after two days.

My surgery has a spiral staircase to different levels.

When I was trying to convince the GP that I had a problem, I suggested that if I climbed the staircase a couple of times it would bring on the symptoms.

He wasn't interested and dismissed the idea.

His attitude meant that he prolonged a proper diagnosis for months.

The same GP thought that rubbing my neck would fix what turned out to be complete heart block.

Non response from pacemaker during exercise

by fullercm - 2024-02-12 16:24:54

Hi

I have been experiencing something similar.  I start getting short of breath after going along just fine.  Cannot do stairs easily or hills.  I remember it wa easier earlier on a2 or 3 months after insertion.  My cardiologist wants to investigate more deeply to see what is going on.  Then they did a stress test which pre PM I would have aced.  I became dizzy and shortof breath after a few minutes.  Cardiologist said it was because my Biotronik dual lead for complete block PM was set to halve the out put in ventricles to 73 when my heart rate reqached 126.  I said but it hasn't always been like this and he said the device has been programmed from the beginning to do that.  He wants to see whether I need a physiological PM.  His concern is to rule out other possible causes of which I believe the above setting is one, before doing that surgery.  I ws told at the beginning that there ws no upper limit because my heart is strong.  Cardiologist said it is so much more complex than that...  will ask about a holter test...

Non response from pacemaker during exercise

by Paul3199 - 2024-02-12 19:34:42

Thanks to all who've responded. Boy, it's a complex matter dealing with hearts and pacemakers. Strangely my pacemaker has been behaving itself most of the time since my post. I spent about a week walking around coastal Tasmania (which isn't flat) and I was pleasantly surprised at my stair climbing capacity. Yes, there's the inevitable start up delay and I have arelatively low ceiling but at 75 I still felt like I was nejoying myself. I suspect cooler weather, hydration and nutrition are all part of the equation. Often on my bike I'll ignore such things because I just like to keep riding. Fingers crossed, it's way better than being chair bound or using mobility aids.

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