Cardiac rehabilitation & exercise stress testing to optimize rate adaptation
I had a state of the art Biotronik Eluna 8 DR-T (dual chamber) implanted last year after my 2nd degree AV block type II (Mobitz) got progressively worse over a period of years of living with it. It usually manifested as exercise induced spontaneous bradycardia with accompanying arrhythmia that would be triggered when I reached a specific HR threshold.
I had the PM programming set initially the day after surgery, and re-programmed twice since then all in an effort to optimize the pacing, and more specifically to get the rate adaptation more sensitive to my highly active lifestyle. It is now on the CLS (closed loop stimulation) setting as it's promoted as the best for rate adaptation, but I've still got issues with it's sensitivity to my exercise regimen. Specifically, it seems more often than not that the PM can't figure out when I'm cycling, which I do almost daily. I've been told it could be the resting rate control, which had a cap in the 90bpm range with a +10 that was just changed to a +20, that could be keeping it from pacing up into the 130-150 range, and partly because when I'm cycling my body position doesn't change and the accelerometer isn't getting engaged. I've tried "tapping up" by manually manipulating my chest while riding to stimulate the accelerometer to no avail, and even if I do a series of jumping jacks or whatever to elevate my HR before I jump on my bike, it's only a matter of time before it will drop back down and then seemingly get "stuck" at the lower rate.
I'm curious if anyone else out there with a similar issue, and possibly similar PM has found specific programming that worked well, either with the CLS and then tweaking the parameters inside CLS, or any other programming modes that were better at rate adaptation.
I'm also curious if anyone was scheduled by their doctor for cardiac rehabilitation, so you could have an exercise strees test with techinician present to tweak the settings real time while imitating your normal exercise patterns.
I've gotten copies of follow up reports so if need be I can refer to them for more specific information about the different parameters set inside the CLS programming mode, but generally right now my parameter overview is DDD-CLS mode, with a basic/night rate of 40bpm and CLS of 150.
Any information or suggestions are much appreciated.