Upper Rate Setting for Cyclist Boston Sci L131

I went in for my follow up 11 weeks after implant. I talked openly about my settings along with what some of my cyclist friends have shared with me. Dr said he normally only made 1 change at a time since one change can affect another setting. They changed my RightRate (MV) from 10 to 12. I asked about my Upper Rate which was set @ 140 (I've hit 160bpm a couple of times going hard on hills during mountain bike rides: MTB). ***Dr did say he would increase my Upper Rate to 170 also***

That being said, went on MTB ride the next day and I noticed during and analyzing after my HR would "Flatline" around 139-140. On MTB ride the terrain dictates the effort, so this flatline would only be for a minute or so. 

Today, 4 days after MTB ride I went on my trainer where I could control my efforts for steady time periods (5 min on w/2 min recovery). After a 20min warm up, I did three 5m efforts @ 180, 200 & 220 watts: I use a Power Meter on my trainer) my HR "Flatlined" again @ 139-140 once I got into each effort. 

Is it safe to say that my Upper Rate is still @ 140? Send nurse a screenshot to communicate to Boston Sci Tech & Dr? 

The only reason I have pacemaker is due to bradycardia. All other parts of heart healthy. No meds.


Upper rate setting

by Gemita - 2023-10-29 06:44:13

Twobigwheels, I am sorry you are still having a frustrating time with your settings, but hopefully you will soon be where you want to be. 

I agree, from your comments, it would appear that the upper rate is still set at 140 bpm after your doctor told you he would increase this to 170 bpm.  Yes, I would contact your clinic again and get this setting increased as soon as possible, so that you can fully test your pacemaker and yourself during your mountain bike rides and start to make some real progress.

Although I agree that changing too many settings all at once can cause difficulties (and impact other settings which might then need adjusting too), if your doctor has already agreed to increase your upper rate to 170 bpm, I see no harm in doing this now, together with the change that has already been made to your Right Rate (MV) setting.  I am however unfamiliar with the MV setting and what impact Right Rate (MV) adjustment from 10-12 might have on other settings, including your Upper Rate setting?

I hope you will soon be able to fully exercise without being held back.

One change only

by Lurker - 2023-10-29 18:34:44

I'm with your Dr. on this one. When I go in I want one change only. If you do 2 and things suddenly go off the rails you don't know which one it was. Now your back to square one.

Good luck on getting the right conditions for your biking.


Doc DX



by piglet22 - 2023-10-30 12:33:41

There are other ways to solve problems, just the opposite.

Professionally, I often had to tackle problems that nobody else wanted to do. Someone had to do it.

My approach was to throw solutions at them until something stuck and gave you breathing space.

Then, one by one I removed the solutions until I was down to one or two and things stabilised. Although the problems didn't kill anyone, I probably wouldn't do it with a pacemaker.

You need to get your settings and try to be more assertive...

by crustyg - 2023-11-02 18:19:52

Most countries that practice Western medicine have passed laws that entitle patients to have access to, and copies of, their medical records.  You should make a formal request for your records which will include all of your pacemaker settings, which will remove the guesswork.

The idea that your EP-team can only make a single change might make sense if no-one had any idea what the effect of a single change might be (the Scientific Method).  But anyone with the time and willingness to read the easily available BostonSci BradyPacer Ref Guide isn't in that position - the guide does a good job of explaining the effect of the settings, and the claim that one setting affects another is nonsense.  Each change may affect the overall Rate Response (and hence HR), but they don't *change* the effect of another setting, except that they may *amplify* the effect.

Think about when you hire a car you've never driven before.  The pedals are in the same place, the steering wheel works the usual way - clockwise to go right, etc. - but the actual usage of them varies from car to car.  The accelerator (more correctly the throttle) may be more sensitive than you're used to, there may a greater effect from ten degress of rotation of the steering wheel (cars vary in the number of turns lock-to-lock), the brake pedal may be more sensitive than you're used to, but it's still the same result, just more sensitive on the controls.

Not increasing your maxHR is just silly and unprofessional, and unless you start to be more assertive - firm but polite, not aggressive - you run the risk of becoming an athletic PM owner who takes years to get your device correctly set for you and your lifestyle.


by TwoBigWheels - 2023-11-02 19:04:22

I see your point. 

When I met with Bos Sci Tech, I suggested settings "a friend in my Bike Club" shared with me. 

There were a couple settings that were different. I have 2m recovery vs 3m of my friend for example.

When @ Drs office, I met with Bos Sci Tech 1st and she said she would discuss with Dr. & left the room with suggestions i made along with discussing UR (I've seen 160bpm+ "hammering" up hills on mountain bike prior to this appt.)

After a bit, Dr came in &  he acknowled he was making 2 changes. (MV from 10-11 & UR to 170). That being said I didn't "visually see" the rep after that. So I'm not sure if she could make those changes from another room, etc. & there was miscommunication. 

That being said I don't think the Dr misled me about my UR. He could have simply said "No". 

Having conversations now with nurse & arranging a follow up.

I will keep the group posted

Remote programming of BostonSci devices

by crustyg - 2023-11-03 05:59:46

These devices can be programmed in two ways: with the heavy magnet/induction coil that sits directly over the device, and the much better ZIP telemetry which uses the built in radio to communicate with the programmer, which works over several feet, and could, in theory work through a plasterboard stud-wall.

I think it's unlikely that a BostonSci rep would reprogram your device from another room, but it's possible.  Very unprofessional, in my opinion, *IF* that's what happened.  But the induction loop *has* to have been placed over your device to initiate a programming session, even if switching to ZIP mode immediately afterwards.  It's designed to prevent concealed device manipulation....

I always offer a USB stick (==thumb-drive) to the techs changing my settings, and after the first time when they were a little surprised, they always copy my reports to the device and hand it back.

There is another reason

by PacedNRunning - 2023-11-03 17:26:17

He probably raised your upper limit to 170bpm but there is another setting that can limit. There is maxed pace rate and max sensor rate.  You'll have to make sure they rasied both and not just one of them.  I would also suggest picking ONE activitty to tweak your PM to. If you use a variety of exercises, it can make it harder because different activities respond differently. You will be all over the place with adjustments.  I picked running. We tweaked it to running and I learned to adapt my other activities with my settings.  Be patient, they will eventually find a good setting. Second, your doctor is right in doing only one thing at a time because it will make it easier to know what did what etc...etc..


by TwoBigWheels - 2023-11-03 21:04:15

Thanks for your response:

Most recent Abbreviated message from my Nurse: "I have been working on my end to coordinate this with one of our representatives for Boston Scientific as they would need to be present to check your device/discuss/adjust settings."

My day job is a Lead Electrician, some flights of stairs and shoveling (if I want to kick in to help my guys out) I'm primarily a cyclist in Chicago USA area entering my off season. Other than cycling planning on lifting/core 2x week. No more than 1 hour each day. Mountain Biking (MTB) is my thing, but limited, if any until next spring. I'm a Polarized guy, so either Z2 work (lots of trainer, so minimal Upper body movement) or VO2 Maintenance (but those "should" drive my HR 140+) work once a week until next Spring

The "test" I forwarded to the Dr wasn't the pace I normally do on the trainer. I was doing 5m on 2m off, stepping power up each time to my approx 40-60m PR.

That being said, went on a moderate Outdoor Road Ride today for 1st time since PM (I have been riding 4-6hrs a week between trainer & MTB) , and HR with my old HR zones was Z2-3,,,while before PM HR would be more like Upper Z1/Lower Z2

Changed MV from 12 to 14

by TwoBigWheels - 2023-11-19 00:00:46

While meeting with Boston Sci Tech, I said that on my 1st effort (interval) on bike rides I my breathing would be surprisingly hard. She changed MV from 12 to 14 (that was only change) saying the change would help with that. They kept my Upper Rate set @ 140.

On mountain bike ride (hill climbs) my HR shot up to 140 and pretty much stayed there the whole ride. This didn't seem to happen before MV change.

On my bike trainer doing steady Z2 power ride my HR would shoot up to 140 since MV change. "It wouldn't" do this before MV change. *I could feel something was up without looking at my HR. I was surprised to see HR @ 140 with the watts I was at.

Doing mild strength work or foam rolling my legs on floor I've seen my HR shoot up to 140. I don't think I monitored my HR doing this work before though.

That being said, sounds like MV change from 12 to 14 to big of a jump?


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