minute ventilations on pacemaker

[KAD]

Thanks for taking my question.  I have a single chamber atrial pacemaker and had it interrogated last week at EP's office.  They programmed my minute ventilations option back on.  They previously had it off because it malfunctioned once and started pacing me at the maximum heart rate when I was lying in bed and rolled on my left side.  They put it back on to try to give me some extra cardiac output with exercise.  My heart rate would only get to 95-100 with running and working out.  When they programmed it on last week, they had me lying still for about 5 minutes or so while it programmed.  It seems to work with working out now, but paces me at my maximum pacing rate with just minimal activity.  For example, grocery shopping it will pace me at 130(maximum pacing rate).  Doing situps and occasionally while I'm lying flat on my back it will pace at 130 and not let up until I change positions.  It's really frustrating because I can feel every paced beat very strongly and sometimes it feels kind of irregular like beat, beat, beat, pause, beat, beat, etc..  I live four hours away from my EP office so I'm not sure what to do?  I could wait it out I guess till January when I change health insurance and have a new doctor in the area I live in.  Is it ok to let something like this wait?  Do you know of a better way to program the minute vent or does it just take some playing around with?  Any suggestions are really greatly appreciated.  I'm very active so I think this function will help.  It just needs programmed correctly.  Thanks

[CCF-M.D.-MJM]

Hi  KAD,

I would call your EP doctors office to let them know this is happening.  It is unlikely to harm you but it depletes your better and is causing your symptoms.  

Your EP should be able to adjust the sensitivity of your pacemaker sensor (more sensitivity, less sensitive).  It is not an on/off switch with only two variables (on/off), there should be some adjusting. It may take some time to figure out the right settings for you but should be worth it in the end.  I hope this helps.  Good luck and thanks for posting.

[KAD]

I forgot to tell you I am young and with a normal heart except for MVP, mild MR and small PFO.  The guidant rep told me a lot of times the smaller younger pacemaker patients need the minute vent option turned on because they don't stamp down as hard with running and exercise, which I guess triggers the pacemaker to give more cardiac output by sensing body movement.  Thanks

[Konopka1955]

Hi KAD,  I read your post and I have an ICD and also exercise and I think what your describing is a feature on my machine called a 'rate response' - and I believe most machines have a low, low/med, med, med/high settings - or something to that effect.  I had to have mine reprogrammed as when I was driving and hit a bump in the road - my ICD would give me extra beats !!  So, I wasn't breathing well when that happened.  So I went back and they adjusted it to lower setting.  Some patients I think are more sensitive - especially if your active.  Like you I had a long drive back to my EP for a change - but it was so much nicer.  The only time it happens now is if I hit a big pothole in the road - but I also realize that I need it to give me more beats when I'm 'moving' exercising.  So, its kind of a give and take.. But, fine tuning to your lifestyle is so important.  I think they want us to have a good quality of life.  I ran a road race a couple weeks ago.  I wasn't fast mind you - but my machine delivered the beats..  So I gave my trophy to my doc..  Luckily I was the only 50 year old female in the race..  :-)  I did tell my doc - I came in first out of ONE in my age group...  Just so he knew - I didn't overdue it..  But I had lots of fun just getting out with my friends..  
Best Wishes
Konopka19555

[axg9504]

KAD: Are you on a PM solely to get more bpm during exercise? My interventional cardio. is recommending one for me and precisely for the kind of reasons you've given which seems to suggest that it would be hard for a PM to dynamically adjust to all situations, I rejected the idea. My situation is this. I start running (9:40 pace) for half mile, my bpm goes up smoothly to 130-140. I then walk/run for another 3 1/2 miles. I have some dizziness on running through mile 2 which then clears up. During exercise my bpm is always above 90. After I stop my bpm flirts with 50-60 for a short while and then goes back up to my normal resting rate. On one solitary occasion it went to 40 and stayed there for 12 hours with symptoms. My cardio thinks my conduction system is breaking down and I will need a PM sooner or later (then why not sooner)
Konopka: You are an inspiration. Do you mind providing your race time (I assume it was a 10K)?

[KAD]

I need the pacemaker at rest also.  I don't have much of a heart rate without the pacer.  They can come close to mimicking a normal functioning cardiac conduction system, but their are still a few kinks.  For example, my pacemaker is very advanced model, it has temperature gauges to speed up my rate with a higher body temp(fever, working out etc..), it can sense body movement and will adjust accordingly(or close to it),  it has the minute ventilations which basically measures the force of your breathing(if your really huffing and puffing it will kick up the rate), it has a pH sensor which analyzes oxygen and carbon dioxide levels in the blood and will pace the heart according to those levels.  It really is actually amazing all it can do, when you think about it.  Do they know why your heart rate drops so low?  I know with extremely conditioned athletes a very low resting heart rate is normal, but I think it's a different story if your symptomatic.  I pretty much feel normal, like I did before the pacer, but right now it's kind of annoying to feel all the paced beats.  Not really a great feeling, but I'm sure it can be fined tuned further.  Konopka, thanks for your suggestions and comments(:

[Konopka1955]

Hi,   Thank You for your kind words.  Your question asked:

Konopka: You are an inspiration. Do you mind providing your race time (I assume it was a 10K)?

Well, over the past 4 years of having this ICD device (since 2001) - and getting 6 shocks in races - I managed to get 9:30 minute miles in a couple of 5k's and 10:04 minute miles in a 10k.  I've also done a dozen or so of half marathons and my best pace was 10:54 in a half.  But got as much as 11:30 minute miles in several.  So it has varied widely.  When I had my Mitral valve severe regurgitation - my pace was usually around 12:00 minute miles - if I was even able to jog at all.  After open heart surgery I got 12:00 minute miles on several races - I managed to get medal or two.  But this year with the CHF it has slowed my pace down even more - I'm just coming out on the other side of having started my new CHF meds and my system is adjusting.  I've been feeling very strong this past week and have been able to give 30 minutes of exercise each day - slowly mind you.  But over the winter I hope to get out and get myself in shape for next years' running season.  I don't know for sure that I'll make it - but I'll give it all I have.  My docs will give me all they have and with alot of 'luck' and hard work - I'll be out running with my friends again next year.    

I've learned over the last 10 years - and I know it's hard to believe one can have this optimizm but it wasn't until I struggled for years to constantly improve my 'pace' that I came to realize - its really not the pace that matters - its all about the 'journey'.  The sheer enthusiasm of being able to participate in life is much more valuable to me and the wonderful memories I've made over the years and hopefully I still have more to come.  This attitude just comes with 'time' and patience.  Until you 'lose' your ability to participate in life - you can't fully appreciate it..

I look forward to getting out next year and have the sun in my face and the wind in the back..  I would dearly love to be able to do another half marathon.  Just one more for the road..  :-)  Of course I'll settle for a 5k !!!  and be I'll be very, very  happy with that :-) Of course I do ask my EP for the 8:00 minute mile program..  He just smiles..  :-)

Konopka1955

[axg]

That's fantastic,given all that you have had to cope with. I'm 61, in my late 30's (when I started running) my best 10K pace was 7:01 and 7:28 for the half. Ran very little in my 40's and tapered almost to a stop although I felt I could still get close to what I used to do. THen came the 50's and I tried seriously to train again, but there was no improvement. At 57 I started getting dizzy spells after 15 mts of run/walk. It seems to go away after a while but then I get tired and have to stop. Now I can't run a mile without walking and could do 8:00 pace for maybe 2/10 mile . I ask myself who was in my body when I ran all those miles. I must remind myself of people like you and try harder I guess..

[axg]

No I don't have the athlete's resting bpm. My rest. bpm is around 78, maybe high 60's if I'm lying down. My bpm goes through a low phase after exercise (sometimes during if I'm resting in between) to 60 when it should be 90-100. It nearly always corrects after 15-30 mts. Sometimes it goes as low as 40 and I do have symptoms. They say I have a sick sinus node and it will get worse. One doc wants to go ahead an put a PM in but I want to wait till I can't do normal activities without one. I didn't know a PM can do all the things you described!