Rate Response

Thanks to the previous post and responses - I think I'm finally beginning to understand Rate Response.

For some reason I've always found it very confusing. Like who needs it and why some people have it ON and some have it OFF.

IF one is paced in the upper chamber (atria) and not or very very little in the ventricle then is it safe to assume you should have the Rate Response ON??????????

Take me, for example:

Diagnosis: Sick Sinus Syndrome. Bradycardia.

I pace 83% in the upper part of my heart (atria)
and less than 1% in the lower part of my heart (ventricle)

Here is my latest Print out from Monday:
(and I don't understand it)

Optimization is OFF (it was ON for the first 5 yrs)
ADL is 3
Exertion Response is 3
ADLR Percent is 2.0%
Activity Threshold is Medium/Low
Activity Acceleration is 15 seconds
Activity Deceleration says Exercise
High Rate Percent is 0.2%
ADL Rate Setpoint is 5
Upper Rate Setpoint is 15

Now - if only I could understand the above I would be a happy camper because my PM tech and the Medtronic Rep both have accents that I cannot understand no matter how many times they try to explain this to me.

Can anyone explain it to me? I understand why it is turned ON to an extent but then come all the other settings/factors as listed above. And please keep in mind that I'm not the most active person on the planet. :) Actually I am quite lazy, the most active I would be is walking when shopping or doing housework.

Thanks
Pookie

8 Comments

On

by Tracey_E - 2010-04-14 10:04:27

If you have SSS and mostly pace atrial, you should have it ON. I'm not familiar with all the settings you have (nothing like mine!) but the ones that say "activity" sound to me like they'd be RR. I don't know the specifics but I know it has a number of sensitivity levels- how fast it kicks in and how high it goes when it senses you are moving.

FRAAAAANNK!!!!!!!

my above posting

by Pookie - 2010-04-14 10:04:37

all the information I quoted above was under the RATE RESPONSE column......or section.


Pookie

Easy Fix

by Philman - 2010-04-14 11:04:11

Call Medtronic at their toll free number. They are very friendly,patient, and informative. They will review all settings in question. Make sure you get the name of the tech to have further conversations. If you are not on meds, you may not need the r/r on. Have you been on a treadmill to see if your h/r will raise itself................ sss can be tricky...

good luck, Philman

yes,, please help!

by Dwight - 2010-04-14 11:04:56

My numbers were quite a bit different from yours under that section, but then again i guess everyone's is a little different. I too wish I knew what they were. Too many categories for us to get a thorough feedback from the Interragators. I think we all deserve some sort of self-study guide/manual that explains all these numbers.
I do know this though. All gasoline powered equipment has dealt me misery. Factory rep tells me vibrations can sometimes cause this with some iindividual response settings. Somebody please fill us in. I haven't a clue.
And good luck with yours Pookie,
Dwight

FRAAAAANNK!!!!!!!

by ElectricFrank - 2010-04-15 02:04:01

OK here is my take. I did some checking in the Technical Manual.

First off I agree that you need RR ON. SSS indicates that there is a problem with your natural atrial pacing. The 83% in the atrial shows the same thing. This means the pacemaker has to determine your HR for you which is what RR does.

Optimization is a feature that uses your measured daily activity profile to try to adjust the rate response for optimum settings. If it is OFF then the settings have to be determined and programmed manually. Apparently, the EP decided that you needed to have yours set. This could be (guessing) that your profile isn't stable so the pacer can't find an optimum setting.

The rest of the settings:

ADL is 3
Exertion Response is 3
ADLR Percent is 2.0%
Activity Threshold is Medium/Low
Activity Acceleration is 15 seconds
Activity Deceleration says Exercise
High Rate Percent is 0.2%
ADL Rate Setpoint is 5
Upper Rate Setpoint is 15

All are settings that tell the RR how to interpret body movement, etc. as it tries to give you a reasonable HR for what you are doing. This includes how fast your HR speeds up when you suddenly get active and how quickly it slows down when you stop.

Does this help? If not let me know and I'll try again.

frank

Rate Response

by ChicagoKim - 2010-04-15 02:04:32

My dear Pookie :)

While I don't pretend to know too much about rate response, I'll tell you what I know about it with regard to junctional rhythm.

My EP said rate response should always be on (I have both movement and respiration responses turned on on my Boston Scientific Altrua) since 1) I'm fairly young and plan on being active, and 2) without it on, I'm more as risk for junctional rhythm kicking in.

He said we might even need to tweak the rate response to be more sensitive to stay ahead of the junctional rhythm if I find that my JR is kicking in before the rate response is... does that make sense?

As I said, I don't know a whole lot about rate response, but it sure seems like it should be turned on, especially with JR issues. Just my take on it.

Kim

rate response

by busby - 2010-04-15 09:04:31

Hi Pookie,
I, also have SSS with neurocardiogenic syncope, but I do not have rate response turned on as I am able to increase my heart rate on my own with exercise. I do, however, have the rate drop response turned ON, due to rapid HR drops. You will know if you have rate response turned on if you are in DDDR mode. I am in DDD mode only. If you have constant bradycardia and when you exercise your heart rate will not go up on it's own, then you are probably in DDDR mode. I hated it when I had it turned ON for the first few months. I do not understand the optimization as mine is turned ON. My other settings are similar to yours, except the ADL rate setpoint and the Upper Sensor Rate Setpoint which are much higher than yours (21,80).
I am considering asking for sleep mode to be set at my next appointment. My last readout showed that the last rate drop readings that morning were just before I woke up and happened every few minutes. I thought to myself, no wonder I don't sleep well! However, I have to be on-call for the hospital during the night and I am not sure if I would be allowed to drive with sleep mode ON. Also what would happen if I wanted to go overseas for a while. It's a pity we can't just adjust our PMs for drive mode etc.
Hope this is not too long
Robin

Another thought on Optimization

by ElectricFrank - 2010-04-16 02:04:14

Unless RR is turned on as in DDDR mode none of the RR settings have any meaning. So if your pacer is set for any of the modes that do not have an R in the name, then the Rate Response settings are just artifacts left over from previous settings.

According to the Adapta technical manual Rate Drop Response (RDR) is programmable in the DDD or DDI modes only (page 75). This means RDR can not be used together with Rate Response.

frank

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