Returning to triathlons after pacemaker insertion

Hi Everyone

I am at 4+ weeks post pacemaker insertion and haven't felt this well in ages! Sick sinus syndrome and progressive reduction in heart rate (especially with exercise) was not an expereince to be repeated.

A keen triathlete, I have slowly restarted training over the last 2 weeks and am delighted to see that my heart rate can actually rise above 100 with exercise! Currently, my Boston Scientific pacemaker is set to accelerometer mode, which as noted by many on these posts is challenging once you hit a steady state. The cardiologist plan is to move to the respiratory mode at 6 weeks. 

I was wondering if there was anyone who can share their experience with this mode in relation to athlete training for triathlon? Are there any special settings or issues to discuss with the cardiologist?



by Tracey_E - 2022-09-07 10:04:58

No feedback on switching modes but I love that your ep gave you the perfect device for your lifestyle and sports. So many don't ask, which is why you see a lot of frustrated cyclists here. Please post pics in the gallery when you do your next tri!

In general, know that the settings are probably going to need tweaked more than once if you are athletic. It is normal to take a few tries to get it just right for you. If they adjust and it's not right, go back. Sometimes it's helpful to do this while on the treadmill so they can watch and program and immediately see if it works.

Good luck!


by stevebne - 2022-09-08 01:05:25

Thanks Tracey! I hadn't thought of having an exercise test to help sort out the best settings and will discuss that with the cardiologist. :)


by dogtired - 2022-09-09 23:12:13

I was not aware that with the Boston you had to select accellerometer or MV, I always thought it was auto switching depending on which indicated the higher demand.  I certainly dont understand why your doc would start in accellerometer then switch at a later time.  In any case biking and swimming are the hard ones to optimize , so I would wait till the switchover then try to get it optimized on a bike erg, not on a treadmill.  It will be interesting to see how well it works for all three sports.  Keep us updated!


by stevebne - 2022-09-13 03:42:29

Thanks Dogtired!

My cardiologist mentioned that respiratory rate meter took a while to settle in as the scar around the pacemaker is an important part of the sensor. Hence only accelerometer initially.

Yes, cycling and swimming are a challenge as once you move to a steady pace after the initial acceleration, HR starts to fall!

Hope to move to RR sensor next week and then see how that goes!


Some BostonSci experience

by crustyg - 2022-09-13 11:03:34

Hi: You will definitely need to get your PM tuned for cycling.  My EP-doc was very kind and got his staff to set up an hour session on a static bike with EP-tech and BostonSci rep in attendance.  Rep and I did all of the work, EP-tech was there for legal reasons.  I had five 'runs' to get the MV mode tuned.  Ideally they need to use ZIP telemetry as the induction loop interferes with the MV sensing.  Also, wait at least 90s after each device adjustment (it disables MV for a short while), and ideally they should force a manual calib after each programming as changing settings dumps the MV calib, as I know to my cost.

Running - that's easy, the accel could get me to maxHR within 350m on factory default settings, BUT I've had mine tweaked and can now achieve a decent HR when pool swimming - you might do better with more shoulder rolling for openwater.  It *might* also be getting some MV support as my settings are fairly aggressive.  Send me a PM and I'll share my settings.

Your EP-doc is correct about waiting to tune the MV - it measures chest impedance from A or V pacing leads to PM case (the Ti shell), so if this is still sliding around in the pocket the data will be useless.  Mine was tuned at 6 weeks.

Best wishes.


by stevebne - 2022-09-24 23:10:19

Just a quick update: post cardiology review my PM was adjusted to a more active athlete mode and I can now exercise (more or less) at the same intensity as 3 years ago! I was particularly worried about cycling and especially on the trainer at home, but the HR response to this is now seemingly normal. Swimming remains delayed to avoid excessive arm movements and the risk of lead dislodgment but will be keen to see how this goes in a few more weeks.

PS: thanks to those who suggested an exercise cardiology review as that is now the plan for my next visit: to arrive at the clinic hot a sweaty after an hour run. (apparently the PM keeps detailed data for the last 70 minutes when interogated by the techs)

„More active athlete Mode“

by The Right Pace Make Peace - 2022-09-28 18:44:20

Please, what is a more active athlete mode?

I've a big interest in your adjustment, because my PM is a Boston too and my problem is seemingly likewise. 

SSS with chronotropic incompetence, AVB I-III

DDDR with AAIR + Accelerometer (step 14) und MV (Step 7) sensor. It's not good und not so bad and different good or bad for Running/circling and not every day is the same …

Have all the time the rigth pace!


by stevebne - 2022-10-02 20:39:37

Hi Make Peace

Send me a PM to discuss further.



by The Right Pace Make Peace - 2022-10-04 19:22:16

Proponent, is that what you want to know?

Active Athlete Mode? What kind of adjustment is this?

best regards and peace from bad pace 


by stevebne - 2022-10-04 22:21:21

I have a Boston Scientific Accolade PM. There are 8 settings for rate adaptive pacing:


Response factor

Activity threshold

Reaction Time

Recovery time


Minute Ventilation

Response factor

Ventilatory Threshold

Ventilatory threshold response

Fitness level



These will determine how responsive your PM is to different forms of exercise. 


Determiniert how responsive your PM

by The Right Pace Make Peace - 2022-10-09 20:08:52

Yes, I know! I Show you my settings:


Response factor: 14

Activity threshold: very low

Reaction Time 10s

Recovery time 2 min


Minute Ventilation

Response factor: 7

anaeroben threshold: 115

anaerobic threshold responce: 70%

Fitness level: Sporty

The rate-responce starts to slow (circling, I need to run in for 5-10 Min for a heart rate of 100/min) and sometimes (rowing), the heartrate go down after 500m rowing (for exampel from 130 to 85/min for short time (1-2Min.), symptomatic) and accelerate then again to an stable acceptable enouph rate.

I have no experience with swimming till now. I must try it.

Do you have an idea? What is your athletic mode?


by stevebne - 2022-10-10 21:31:05

although rather technical, it is best explained by the BS reference guide:

See pages 2-33 through 2-47 regarding rate adaptive pacing.

I rang the local BS office and the tech adviser went through this with me so I could best understand how the PM works in exercise. For me, effectively the accelerometer settings are most relevant to running, the MV settings to cycling. My response factor is 12 for both, which means the PM rate kicks in easily when I start exercise and my HR remains high for exercise that can extend over 3+ hours. Note that I have fitness set at endurance, which stops the baseline from resetting for at least 4.5 hours. My VT is 140 which stops the fall in response to 70% too early.

Hope this helps


Fitness set at Endurance …

by The Right Pace Make Peace - 2022-10-19 19:38:40

It's a preset?


Thank you very much for show me your adjustment. It's a good idea to visit an Boston technician. I don't know if it's possible in germany too.


If you've interest in, I give you a update later on.


Best regards



To Steve again

by The Right Pace Make Peace - 2022-10-19 20:20:46

What is you mode: DDDR OR AAIR-DDDR …?


by stevebne - 2022-10-20 20:03:30

I only have an atrial lead for atrial pacing. 

I rang the Boston Scientific office in Sydney, Australia and asked to speak to the tech person who was more than happy to spend 30+ minutes explaining the settings and how each impacts on exercise. You could always try them....

You know you're wired when...

You participate in the Pacer Olympics.

Member Quotes

I am active and healthy and have been given a second chance.