for Electric Frank or any of you that can explain it

What are the pros and cons of having the rate responsive setting turned off or on? I really don't understand the reason for it. Thanks for your info... aldeer

7 Comments

thanks, Smitty

by aldeer - 2009-01-14 02:01:30

Your explanation is just great. After reading it, I looked at my pm check and found it is turned on. The atrial is not applicable because I just have a single lead to the ventricle (3rd degree heart block) My low rate is 60 and upper sensor rate 130 so what does the ADL rate at 105 stand for? aldeer my rate is often at 100 when anxious or just doing dishes. Just grateful for this fantastic little device!

Mine drove me nuts!

by dward - 2009-01-14 06:01:44

Mine used to make me feel like my heart was competing with my PM.
Turns out I didn;t need it on (thank God!)
Similar to Smitty's "test" - they turned mine off and made me run up and down the hospital hallway 3 times (boy, did I get some strange looks!!)
As soon as they truned it off, I had no problems.
I'm thinking if I DID need it, I likely wouldn;t have felt that "competing" feeling.

rate response

by Tracey_E - 2009-01-14 10:01:12

The others can explain it better but rate response is when the pm is sensitive to your movement. It senses when you are more active and raises your hr. If your atrial rate doesn't increase like it should, this will help you. If your sinus node (what controls the atrial rate) is normal, rr can fight with your own hr and not feel so good.

Rate Response

by SMITTY - 2009-01-14 12:01:08

Hello Aldeer,

Your's is an interesting question. My answer would have to be it that it all depends on whether it is needed it or not and that is not always a true indication of whether a person should, or should not have it activated. Many people have this feature on their pacemaker and do not even know it is there,. It can be a real benefit to some (if needed) and a real pain to some (even IF IT IS needed).

The rate response monitors your heart rate and physical activy and if you start physical activity it deems will make you need a faster heart rate it will increase your heart rate to whatever it thinks is appropriate. The ringer is the pacemaker cannot always tell the difference between actual physical activity and simply body movement. Some months ago we had a member telling about the rate response feature increasing their heart rate because they were traveling over a very rough road.

As for me, I wish I could have mine restarted. I've had it started and stopped on two occasions. It would increase my heart rate with physical activity, but the nurse/technicians could never get the timing set as needed and the PM was starting the contraction of the ventricle a millisecond or two before the atrium finished its job of transferring blood into the ventricle. This resulted in the ventricle putting back pressure on the mitral valve and it hurt. Not extreme pain, but about like someone hitting me with a small hammer in the middle of my chest. I've tried getting the settings improved but when it hasn't worked and I had it turned off. I don't want chest pain whenever I increase my physical activity.

For someone wondering if they need their rate response activated or not, I use a simple test they can try also. Standing in the middle (get in the middle so if you fall you don't hurt yourself) of the room check your heart rate. Now run in place for about 20 to 30 seconds. If your heart rate increased several BPM then you probably do not need the rate response activated. If your heart rate stays the same then you may benefit from having rate response activated. But, if your heart rate does increase from the exercise, then I say leave things alone.

Now back to your original question, I don't think there are any real pros and cons. I think a person either needs it activated or they don't. If they do need it and get it activated, then like all things with a pacemaker, it may be good or bad for a particular person. If it is not needed why activate something that could confuse the issue of a regular beat.

But the fact that you have asked the question probably means you need to talk to the doctor about this for you.

Good luck,

Smitty

Single lead?

by ElectricFrank - 2009-01-15 01:01:23

Are you sure you only have a single lead to the ventricles? This would be rather unusual for AV block (heart block is a marketing term to make it sound ominous) because the electrical block is between the atrium and ventricles. The optimum setup for AV block is to have an atrial lead sense the atrial beat and use it to time the ventricular beat. Since in many cases the atrial rhythm is still OK this restores normal heart activity.

Rate response is only meant for a condition where there is no natural atrial pacing. In this case the optimum setup is to provide pacing to both atrium and ventricles. There is a motion sensing device built into the pacemaker that uses the movement of your body to determine an appropriate rate under various conditions.

There is a mode where a single ventricle lead can be programmed to pace using rate response, but it lacks the efficiency of atrial/ventricular timing. Its main use is in the case of a failed atrial where it can provide backup pacing. I think it is also used in a situation where the battery is getting near the end of its life to save on power.

I hope this isn't too technical. Be sure and ask if you need anything more.

best,

frank

backwards

by Tracey_E - 2009-01-15 09:01:54

Sue, rate response is more for atrial problems when the sinus node isn't working as it should. AV blocks are a ventricle issue and usually do not need rr because our sinus nodes work normally. I would question it if they're telling you that.

I have something turned on called rate drop response (or something like that, not sure of the exact name but it sounds like RR), not the same thing as rate response. It keeps me from sudden drops. I can be cruising along at 150 when i work out, drop to 120, then jump up to 150 again. My primary problem is av block but sometimes I get these atrial drops, we found it on a stress test when I complained about getting dizzy when working out. They turned it on and the problems went away.

Rate Response

by ElectricFrank - 2009-01-15 11:01:26

That is not true. Heart Block is exactly the condition I have and my dual lead Medtronics has rate response turned off. I had the same experience and had to make it clear that if the cardiologist wouldn't turn it off that I would be looking for another cardio. It's been off for 4 years. Having it off lets my own natural pacemaker set my HR with exercise and it does a better job than rate response.

I don't like the term Heart Block as it can be misleading. It is easy to mix up with blocked arteries which is something entirely different. AV block is a more correct term.

frank

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