Four years in

So I'm four plus years into my first PM, Biotronik Eluna-DDR. My doc recommended it because of the rate reponsiveness of the Biotronik technology, CLS, since I am a very active 73 year old (Jogging, gym, skiing). Things have gone pretty well. Each year I push the doc to up my top rate because I seem to (according to my HR watch) be pushing against the upper limit. When running, for  example, I run out of oxygen before my legs get tired. Started at 120, now up to 150. Last time I saw him he balked at going beyond 150.(I asked for 160)  Said he would increase the responsiveness to see if that helped, but I really don't see much difference. He also made a vague comment about CLS not really performing as well as hoped. Any other comments on this?

One other thing that I do note: I can run a fairly long distance (3 miles at but when I am doing chores that require moderate upper body exertion, I get out of breath fairly quickly. Not sure why. Others have this experience?


4 Comments

Type of PM?

by Jackw - 2019-04-21 16:50:20

Swangirl:  Thanks for your comment. Do you have a Biotronik pm? They have a differnt type of rate response from other pms not tied to the accelerometer. (in fact, the acclerometer on mine is turned off and CLS is turned on). CLS is supposed to sense "changes in cardiac contractility" to determine demand for more blood flow and increase the rate accordingly. Not sure your clever strategy for increasing the rate would work on mine.

Ventricle pacing

by AgentX86 - 2019-04-21 23:27:31

The answer to "pacemake syndrome" is the third lead (biventricular or CRT pacing).  I'm 100% ventricle paced (no atrial lead at all).

You're right, no currently used rate response method is anything close to being as "responsive" as a normally functioning sinus node.  Alas, that is not to be for a good many of us.

 

Exercise with a Biotronik Eluna 8-DR T on CLS programming

by darmaggi - 2019-05-29 16:23:45

Jack, I wish my Cardiac EP was more concerned about the optimization of my PM, but most of the time when I go in for a follow up I only see a Biotronik tech, and they've had issues dialing in the PM to my satisfaction. I've had this Eluna for almost exactly two years.

Why have a state of the art PM if you can't return to your active lifestyle.

My PM is currently set on CLS, although when first implanted it wasn't, and the techs have made adjustments to the parameters after being set in the CLS a few times, but I'm still experiencing times when it gets stuck in the 90's, usually when I'm cycling, but when it does adapt properly and gets into the 150's I feel like superman, compared to pre-pacemaker days when my ticker was limited by a 2nd degree AV Mobitz type 2 blockage and was progressively getting worse with the upper limit topping out in the 60's.

I also am very active with a combination of weight training, swimming, and cycling, and I've got a theory that the Biotronk techs don't ordinarily see enough really fit patients of any age to have a sufficient base of knowledge on how to set the parameters inside the CLS to optimize the rate adaptation. I've boned up on my device on line and with Biotronik tech support to try and isolate what could be causing it to get "stuck" below an optimal level. They've tweaked a variety of parameters, and it sounded like resting rate response might have been the culprit so we elevated that, but there are times when I could go for a 30 mile bike ride and never see it climb above 100. They say the accelerometer isn't fully functional while CLS is in command, but it seems like if I do calisthenics and get my rate up before I jump on the bike I can go for the exact same 30 mile ride up to Malibu and average in the 130's. Although, even when I do that sometimes if I get stopped at a traffic signal too long it can drop too low and get stuck. I've also tried the suggestion of tapping up to no avail, but I'm sure I look funny banging on my boob while riding. Intermittent activities seem to cause less adaptation problems, or I just may be more aware when it's more of a steady state exercise like cycling.

I've suggested an optimization session with a stress test on a treadmill, or optimally stationary bike, and have the tech there to witness and tweak the PM real time, but haven't gotten both my cardiologists on board yet.
I'm seeing a tech tomorrow morning and I got them listening to me better and are now tweaking one thing at a time to try and isolate the issue, instead of making several changes all at once.

If you've gotten clued into the CLS settings that are ideal for an athletic lifestyle I'd love to know what they are.

Cheers,

Mark

 

Biotronic Eluna parameters

by Jackw - 2019-05-29 18:15:03

Mark:

I don't recall what the settings are now. I'll ask for some details when I see the EP in late August. Thanks for your comments.

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Sometimes a device must be tuned a few times before it is right. My cardiologist said it is like fine tuning a car.