Fast heart rate all night with biotronik CL S

Hi can anyone help, I got my Cls activated for the first time yesterday after starting off with just basic levels at 60 during the day, 50at night which was an improvement but didn't give me the quality of life I hoped for. I have chronic bradycardia due to brain injury but can mount a good response to exercise, am just not so good sitting still and can't stand in one place without fainting which is why I got the PM.

The Cls function was sold to me like it would be the dogs bollocks for my situation and in the daytime yesterday I really felt good, much better hr than I would have had on the previous settings, able to sweep my garden, it was all great until I went to bed.

I have been kept awake all night with a racing pounding heart, going randomly from 60s to my maximum of 80, which thank God it can't go any higher. I have never taken drugs but I am pretty sure this is what a couple of lines of cocaine before bed feels like.

I am so disappointed as I cannot sacrifice sleep to have a healthy heart rate by day, so am going to call the clinic as soon as it opens.

Can anything be done about this or is it just a choice between Cls or go back to basic rates with a night time one that lets me rest but a daytime one with no responsiveness?

Any ideas would be much appreciated.

My base rate is currently 55 but I have been nowhere near that all night. Max rate 80. Sensitivity medium. I am not sure about resting rate control but think it is 20.

I just don't understand why it is going the same or higher at night when lying quietly in bed than if I am up and active? 




Probably needs more tuning

by crustyg - 2022-03-31 04:22:25

I've heard good things about Biotronik CLS from the EP-techs at the large centre that I attend.  But Biotronik isn't a vendor that they use - they already have enough variety.

The basic principle is quite clever: monitor the strength of each heartbeat and use that to drive the Rate Response feature of the pacer.  Since the nerve supply to the heart is intact, and this is a major factor in how powerfully the heart beats (but not the rate for those with a failing/failed SA-node or SSS+CI) this makes sense.

However, there are other circumstances where you might normally expect to have a powerful heart beat - watching a film with sudden, thrilling moments (you can often feel a couple of powerful beats) or at night as you dream, even after a heavy meal, and if all of these more powerful heartbeats drive your HR up then you'll have a problem.

Thinking as a software engineer for a moment, the obvious first step is to set your device to wait for several powerful heartbeats before triggering a rate-response, and for sleeping, apply a nighttime mode where CLS responses are all damped down.  Delay/pause before activation of RR must be programmable in your device, and some vendor PMs have a nighttime setting to reduce RR for exactly the same reason (usually a much lower minimum rate).

So I suspect you need to start with a tuning session.  Unlike more traditional PMs (e.g. BostonSci Accolade) I think you're going to need several tuning adjustments over a couple of weeks to get this right for you.  With luck they will understand that getting the best out of the device for you is an iterative process - it's definitely not a fit-and-forget type of device.

Yes, more tuning

by Persephone - 2022-04-02 18:04:22

Hi Daisies - I similarly thought "what have I done" to request CLS be turned on for my Biotronik device (although I had thought it was turned on at time of implant, but that's another story). There was definitely a break-in period where my HR felt too high. Over the long run, though, I am very comfortable with it and can really do most of what I want/need to do, compared to prior to the CLS activation, when I was more limited in activities due to some SOB. I felt the trade-off was worth it, in my situation. I suggest giving it a bit more time to settle then ask for a follow-up.

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