Hi, I had my HA in August, recovery going well and I will soon speak with the specialist regarding a pacemaker / crtd on the NHS. But I have a question for anyone here who has had one implanted:I'm an active runner and plan / hope to be able to continue as much as I possibly can. I obviously don't want the device to zap me when I am running or working out. I'm 44 years old and extremely fit. Will I get the opportunity to decide for myself at what level the device is set at or will I have no say or will it be decided between myself and the doctor? I'd probably want the device set to 170-190. I'm currently managing to jog under 120 on the advice of the cautious physio with no probs at all.
Anyone been in a similar situation?
Thanks in advance.
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Maradona10
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My understanding is it will be decided mainly by the consultant, though they probably do take into account your lifestyle etc is & what would be the highest HR you could achieve without it causing you problems. When you have the device fitted they do various tests so they can adjust the settings to your needs, one of those tests is using the device to speed up your HR to see how your heart reacts. Some people are aware of their heart racing when they do the test, others are not. They do this annually, or sooner if needed, and adjust settings when necessary.
However, your HR tolerance can change. For almost 12 years my husband's ICD HR tolerance was set at 180 (I believe most devices are initially set at that rate if the device has been fitted as a precaution & not due to an event) if his HR went above that his ICD would pace him down and/or pace him out of any VT's, which it had done a few times over the years. However last year he started having VT's & his device wasn't kicking in as the VT's were happening under the HR of 180 so his HR level was reduced to 145. Unfortunately he continued having VT's which again were under his HR of 145 so his HR tolerance level has now been reduced to 128 & his ICD has been adjusted to treat him aggressively, however in reality they don't want his HR to go over 101!
Tbh, they only fit these devices if there is real concern that you could go into dangerous heart rhythm & cardiac arrest. If the consultant thinks a certain HR would be too high for you & likely to cause a dangerous rhythm then I would say it's very unlikely they'll set the device at that HR as there wouldn't really be much point in you having the device fitted.
These devices are smart and know what is a normal heart rhythm and what is an abnormal heart rhythm. It should only fire if it detects an abnormal heart rhythm, not when your heart is beating fast because you are exercising.
The cardiologist and the pacing team will make an initial decision on the type of pacing needed for a particular condition when a pacemaker is first fitted.
My daughter has a complex congenital heart condition and she has had a pacemaker for many years. Given her experience and accumulated knowledge about her condition she is able to have detailed discussions about pacemaker settings with her pacing team. As happened recently, the team made some adjustments to a replacement pacemaker. My daughter was then told to go out for an hour or so to see how the changed settings impacted on her day-to-day activities; eg, climbing stairs. The team then ran a second pacing check and made some further adjustments based on patient feedback and the pacing results.
Hi, I would make sure the consultant and pacing / device team know about your lifestyle and exercise levels and ask them how they plan to configure the device in light of that. Hopefully they can re-assure you about how they have configured it. I find I have to be a bit persistent with the questions to get to the bottom of what they are doing to my device at the device clinics. There is a lot of fiddling on the ipad that is programming my device and sometimes the detail of what they are doing isn't forthcoming!
From my understanding the machine picks up on elevated heart rate as a factor in its decision to deliver a shock. So my question was, "what is that higher heart rate level that might trip the shock and can it be adjusted to allow for more intense exercise?"
I would be surprised if that is right - why would the machine deliver a 'shock' if the heart rate is elevated? and what would such a 'shock' do? - but I may be corrected by others who know more.
A too slow, fast or abnormal heart rhythm will trigger the device to try & correct the HR and if that's not successful then it will deliver a shock. An ICD/CRTd has parameters set to the patients medical condition, what is considered high for some will be considered normal/acceptable for others. My husband has an ICD, his ICD will kick in if his HR goes below 50 or above 128, OR if there's any abnormal rhythm within those numbers. Some people are not able to tolerate high HR's (as my husband isn't) so the parameters on the device are individual. Hopefully the link below might be able to explain it better.
Oh right, I don't know much, if anything, about pacemakers themselves & how they work, just that ICD's & CRT's have a pacing facility which is where the shock part comes into it. What does a pacemaker do if your heart goes on a bit of a wobble?
Ah, that's similar to my husband, though he gets tachy-brady. The pacing on his ICD is set to pace him at 50 & to start trying to pace him down at 120.I hope you don't mind me asking a question?
Do you ever take your pulse manually and find it's actually a bit lower than the 50 so there's probably a delay in the device pacing you back up?
It's a crt defibrillator. That's what they do. give small shocks to synch the chambers of the heart and give big shocks to stop you from having a fatal incident. Like the paddles... "clear... ZAP"
hello,I had my crtd fitted at the age of 46,which is nearly 10 years ago now ! I am due for a box change in next 6mths. Mine is set to pace @40bpm&to shock@ 188bpm on an abnormal rhythm.this is the important bit,it will not deliver a big shock unless it detects an abnormal heart rhythm,the device will as I was told give my heart a little ping to start with&if that does not work it will give a slightly stronger ping,then if that does not work it will shock me!!! I throughout the 10years have never thankfully had “a shock” but had many many pings but am never aware of them,only what I am told when I go in to have my check ups. This is a device I certainly never wanted,but am glad I have,as I carry out a normal busy working life without the worry of sudden cardiac event/death. Hopefully you will have an excellent cardiologist as have I who I trust in his every word,an listen to what he says,the start of my journey was not easy,they loaded me with meds,I struggled to take every single one of them,it took me 7ths to stabilise,I take them religiously now&i think that is the reason why everything works together&where I am today.i do hope this may help you in some way,but certainly do not be frightened to ask your cardiologist loads of questions,I always took a note book. Good luck in your journey Bev
Thank you, very reassuring. How did you find the first three months with the device... How long before you were told you could move your arm around properly etc?
Ok if I am going to tell truth,depressing,every time I saw the scar,I cried! As for moving arm,you must move,but not above head/shoulder(not moving you are at risk of frozen shoulder&thats even more problematic)I did use mine I didn’t walk around with it glued to my stomach,I moved freely from the elbow,and lifted whole arm gently,no stretching above head/shoulder,carried lightweight things with it ie cup of tea,plate etc,normal things.i moved everything in kitchen/bathroom to waist/chest height&managed fine.didnt drive for 4/5wks that was strangest! My motto is it lives with me,not I live with it!!!
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