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Heart Disease (Expert Forum)
Pacemaker Settings
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Pacemaker Settings
by wen, Feb 26, 2001 12:00AM
My Pacemaker is set at 60 bpm as its lower setting. I am two weeks post implantation, and was already cleared by my physician to resume running. I am mid 50s, F, and run about 20 miles/week. Prior to implantation my resting pulse had been at around 42, declining at times (per event monitor) to low 30's (at which time I was symptomatic - i.e. fatigue, lack of concentration). I feel good at this setting, but wonder, (1) is there an advantage to setting it lower - to the lowest rate at which I would still feel comfortable? After all, athletes are always so proud of their low resting heart rates - why would I now want to go the other way - to a rate higher than might be required? (2) Also, the only time I feel a little "strange" is when I just start running. It feels like the pacer picks up the rate more quickly than I need. Is this something that needs to be adjusted - or rather something better than my natural rhythm, to which I should get used to? (3) How careful does one have to be about touching the sight of the Pacemaker? The strap on a sports bra would press on a corner of the sight. Is this a No No?
Thanks for previous answers, and encouragement to go forward with implantation. I do feel better - like a fog has lifted.
Thanks for previous answers, and encouragement to go forward with implantation. I do feel better - like a fog has lifted.
Doctor's Answer
by CCF-M.D.-CRC, Feb 26, 2001 12:00AM
Dear Wen,
I'm glad to hear that you went ahead with the pacemaker and that you feel better. It is possible that the settings of your pacemaker will need to be "fine tuned" to get you feeling even better. The lower rate of 60 is sort of a generic starting point and could be set lower although I don't really think there is much advantage to setting it lower. I think your other observation is more significant and the "rate-response" settings on your pacemaker may need adjusted. Do you know the brand and model of pacemaker you have? The rate response setting on the pacemaker controls how the pacemaker responds to activity (how fast, how soon, the slope of the response, etc.). This setting may be adjusted in a variety of different ways to optimize the response for you. I would discuss the problem with your doctor. He/she may want to have you do an exercise test to help set some of the parameters. It would probably be a good idea to have a representative from the pacemaker company there to help with some of the advanced programming. He may wait until 4-6 weeks after implant for the final progamming. It may take a few sessions to get things the way you like it for your running. We have expertise in dealing with pacemakers in athletes here at the Clinic and have some patients who have required several sessions of advanced programming so they could perform at peak level. If for some reason your doctor has difficulty in this area he may contact Dr. Bruce Wilkoff here for additional assistance or to refer you for a consult.
You don't have to worry about touching the pacemaker site once the skin has healed over. Again, I'm glad to hear that this has worked out for you. Keep us updated on your progress.
I'm glad to hear that you went ahead with the pacemaker and that you feel better. It is possible that the settings of your pacemaker will need to be "fine tuned" to get you feeling even better. The lower rate of 60 is sort of a generic starting point and could be set lower although I don't really think there is much advantage to setting it lower. I think your other observation is more significant and the "rate-response" settings on your pacemaker may need adjusted. Do you know the brand and model of pacemaker you have? The rate response setting on the pacemaker controls how the pacemaker responds to activity (how fast, how soon, the slope of the response, etc.). This setting may be adjusted in a variety of different ways to optimize the response for you. I would discuss the problem with your doctor. He/she may want to have you do an exercise test to help set some of the parameters. It would probably be a good idea to have a representative from the pacemaker company there to help with some of the advanced programming. He may wait until 4-6 weeks after implant for the final progamming. It may take a few sessions to get things the way you like it for your running. We have expertise in dealing with pacemakers in athletes here at the Clinic and have some patients who have required several sessions of advanced programming so they could perform at peak level. If for some reason your doctor has difficulty in this area he may contact Dr. Bruce Wilkoff here for additional assistance or to refer you for a consult.
You don't have to worry about touching the pacemaker site once the skin has healed over. Again, I'm glad to hear that this has worked out for you. Keep us updated on your progress.
I am an active 65 year old male with a St. Jude Pacesetter dual chamber rate responsive pacemaker installed in May 2000. After a bad ride across Iowa on my bike, I have been working with the technician and have adjusted it several times, but still have some minor problems. When running hills and slow down my pace, the accelorometer in the pacer senses less motion and slows down my hert rate, therefore I slow down, and so on. We set the recovery rate to 'very slow' and this has helped as the HR stays higher longer. Same on biking and swimming, if my motion slows, the HR slows regardless of my physical effort.
Like you, my normal resting HR was about 45, now it is set at 60 with no problems.
I am not using the 'V' chamber pacing, and we have also discussed setting up to pace only the 'A' chamber, as this will allow us to set upper limit to as high as 180. Now I am lilmited to 140, and exercise at that rate 100% of the time, even though I need to go to about 145-150.
We are discussing a replacement pacemaker with an oxygen sensor.
How has your exercise been going and what problems have you encountered since your posting?