Thank you and one more question

Hi all,

I just wanted to thank those of you that responded to my post regarding my new pacemaker. As I mentioned previously, it's been a difficult adjustment for me and your comments have been really, really helpful.

I mentioned I was getting dizzy after running and a few of you suggested I have my rate response turned off which makes sense to me. It's currently set so that if I'm not exercising, the highest my HR can go is 120. However, I think there's a motion sensor which allows my heart rate to go up to 170 when I'm exercising. Some of you said I should contact my PM rep, but I'm not sure how to go about that. The only contact info I have is for my EP. Should I start there? Also, is there any good reason why I would need rate response kept on? I'm an otherwise healthy 32 year old woman with AV block. I just want to make sure I'm armed with info before I call my doc.

Thanks again for all of your encouragement and I'm so glad I found this site!

3 Comments

ep makes appts with the tech

by Tracey_E - 2008-07-18 02:07:46

My rep is my tech and he comes to my doc's office. I set it up through the doctor. They have one day a month that they are always at the doctor's office but they'll meet me there if I have a problem in between. Some folks here go to a pacer clinic instead.

When you have an AV block, your atria beats just fine on its own and increases with exercise the way it should, you just need the pacer to make the ventricle keep up.

My understanding about rate response is that it's a safety measure for arrythmia and fibrillation. If the atrial rate gets too high, it throws you into a block- 1 ventricle for 2 atrial beats instead of 1:1. Great idea for patients who fibrillate and don't want their heart rate suddenly shooting up but annoying for otherwise healthy patients who want to work out! We're trying to work out but the pacer thinks we're fibrillating so it keeps the ventricle rate too low. If they turn it off, your ventricle will keep up with your natural atrial rate up to whatever your set max is, probably between 140 and 160.

Hopefully I'm not confusing rate response with something else so someone please correct me if I'm wrong! I just had this as well as two other things reset so I might be mixing them up.

When you meet with your tech, chat and ask a lot of questions. Make it clear that you want to understand what's going on, they should respect that and be willing to explain things to you. I also always ask about their kids and every once in a while I show up with homemade cookies, lol. We're usually remembered by the staff just because of our age but I've worked to build a good relationship with them so that when I need to get their attention, I'm not just a name on a file and they don't brush me off.

p.s. don't think you will always have problems like this!!! I can count the times on one hand that I've had any kind of issues in the 14 yrs I've been pacing.

Rate response

by Vai - 2008-07-18 12:07:11

Did the EP told you why the rate response was necessary and turned on for you?

My rate response was never turned on since the PM implant. My doc and PM tech told me something like this -
- low setting was 60 bpm and my heart rate can naturally increase with activity
- the natural exercise heart rate is comfortable for me that is I am getting enough oxygen to feed my increased activity (usually this would be about 140 bpm for me).
- advised not to push beyond 160 due to other factors like AFIB and CHF.
In such circumstance the rate response is not needed.
Sorry my knowledge of rate response is rather limited.

You can check with the PM tech who checks your settings and do the interrogation of the PM on how to contact the PM rep. In the clinic I visit the PM tech is regularly around and chats with the patients.

Rate response

by ElectricFrank - 2008-07-19 12:07:30

It doesn't sound like you need rate response. The AV block is a condition where your ventricles don't get the message to follow the atrial beat. The pacemaker just wire around the problem and all is well. The only reason for rate response is if you have something like Sick Sinus Syndrome where your atial pacemaker isn't doing its job.
I also have AV block (100%) and have had rate response for over 3 years. The nice thing about it is having a natural response to exercise. Last summer I spent time above 13,000ft and my heart did its thing and beat faster to make up for it, just like it is supposed to do.
Even with rate response off, the pacer will still enforce the upper limit setting by skipping ventricular beats like TracyE mentioned. Being in good shape even though I am 78, I insisted on having the upper rate limit set high enough that I never encounter it during exercise.

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