Experiences with closed-loop stimulation

Hi!

I was wondering, if anyone of you has a Biotronik pacemaker with closed-loop stimulation (CLS), a special rate response mode, switched on. How do you get along with that - in daily life or when exercising?

I'm in the process of deciding whether to go for a pacemaker with a better rate response, and one of the EPs in my professor's team said that CLS might work for me. However, my cardio, who also implants pacemakers, said he implanted Biotronik pacers with CLS in several patients, and had to switch this feature off in all patients shortly after implant. Apparently, they were all having problems with inappropriate tachycardia and palpitations, because the CLS kind of "over-responded" with high rates with minimal exertion.

When I first read about CLS, about six years ago, I was thinking that it's really cool since it also responds to mental/emotiona stress, and not only exercising. But then I hardly ever got to know anyone with CLS. The only person I got to know had problems with her CLS settings. So, maybe it's not implanted that often because it doesn't work very well?

Comments are greatly appreciated. Thanks a lot!

Inga

9 Comments

Biotronik

by cohara - 2013-07-02 10:07:12

Snitch,

I have a Biotronik Evia pacemaker with CLS rate response. The only problems I experienced were the result of not having the rate response activated. I couldn't even remove clothes from the dryer without getting lightheaded. Once the rate response was activated, things sorted out. The initial setting was at 120, but that was too low. All seems fine so far at 135. I've had this setting for a couple of years now.

I am 100% paced with no natural rhythm. I am not sure if anyone who is paced occasionally would fare as well. Perhaps there is someone on the site who has seen the darker side of Biotronik, but for me, so far, so good.

Good luck,
Carol

Thanks a lot, Carol!

by golden_snitch - 2013-07-02 12:07:27

Are you exercising regularly, as for instance going running or swimming or cycling? If so, any problems with that? Does your pacer increase the heart rate when you walk up the stairs? Sorry for all the questions, but it's really difficult to find someone with CLS switched on. Thanks again!
Inga

CLS

by swallace - 2013-07-06 05:07:13

Inga,

I had a Biotronik PM put in a year ago. I went into emergency thinking I was having a heart attack (it was actually bradycardia), having not had any previous warning that I had a problem, and came out a week later with a PM. Therefore, I haven't really looked into exactly what they put in, but it sounds a lot like CLS. When I exercise, or feel stressed, the PM gives me an elevated heart rate to mimic what my sinus node should be doing. My settings are 61-150. The PM kicks in if my sinus node (I have sick sinus syndrome) is not giving me 61bpm resting heart rate OR its equivalent depending on my activity level. The upper setting was 120, but, after 3 months, I asked for it to be increased as I wasn't getting the "performance" out of it that I needed. It was a bit like when the speed regulator in a golf buggy kicks in. As a 38 year old man, I jog, swim, play cricket and touch football without any real problems. However, stamina is an issue - I find that I fatigue a lot sooner than I used to. At times, I also get light headed and forgetful, or I have trouble making an instant decision. It seems to me that my brain does not always get quite enough oxygen. Hope that was helpful - just remember that we are all different, so our experiences may also be different, and a PM will probably never be as good as normal heart function. Still, if you need one, it's better than the other option.

Your Lower Limit

by donr - 2013-07-06 09:07:02

Is it REALLY 61 BPM? MY cardio told me when I got my first PM that they could only program them in multiples of 5 BPM.
I had asked for a lower limit of 72 - my old, historically common "Resting" HR.

Have they changed or improved the capability for programming? Is this a capability peculiar to your particular device?

Don

Biotronik

by Harrie - 2013-07-07 12:07:15

I had my Biotronik Evia implanted 8 weeks ago. Don't know if it has CLS, but it is able to respond to emotional states etc. the manual says that rate response is not suitable for everyone, and each device needs to be programmed to suit the needs of the individual. I had it switched off after 6 weeks because it was increasing my heart rate too much after limited exercise and my cardiologist said I didn't need it. Hope this helps! Interesting that you have a choice about what device to get.

Lower Limit Answered and Biotronik

by swallace - 2013-07-08 02:07:33

Don,

61 bpm is what the cardiologist and Biotronik technician said. I'm going to see them again for a chekcup soon and I will ask them for 70 bpm as the lower limit - what I always was until I got sick sinus syndrome. It's quite incredible what they can do, although, at one point during a consultation the tech guy accidently sent my heart rate up to about 100 while I was sitting down - a rather disconcerting experience! He quickly brought it back down. There are also three (maybe more) "responsiveness" settings. I have ended up on the highest as I need a quick change in heart rate when I run or swim. I found the low end was a bit laggy and clunky, so to speak.


I also agree with Royale, who seems to have gotten the same PM as me. It is interesting that Inga is being offered a choice of devices. Mine was just put in and then I had a visit to my hospital bed from a Biotronik technician the next morning. I didn't have clue about companies or devices up to that point. Apparently, Biotronik have "the contract" for the hospital I was in, or something along those lines. I am pretty impressed with them, but I must admit I'm still very new and ignorant in all this.

Lower Limit

by swallace - 2013-07-08 02:07:44

Don,

Just on your last two questions, I have little idea about other devices, but I would suggest that the rate of PM improvement and innovation has been similar to computer improvement and innovation - exponential. And that's what a current model PM is - a complex computer.

Biotronik Entovis DR-T

by gaman - 2015-04-25 02:04:05

I had a Biotronik Entovis DR-T dual lead pacemaker (1 lead in Rt. atrium; 1 in coronary sinus) put in 2 weeks ago. I'm not seeing any real increase in heart rate during exercise so I'm thinking my CLS might be switched off. I have to go back for a checkup in a little over a week as the pacer check last week revealed a high impedance in coronary sinus lead. Capture voltage of coronary sinus lead had increased from around 1 volt at implant to about 3 volts so I'm concerned about battery life. I'll definitely find out if CLS is switched on then. Note that my base heart rate is stable in the 60's-70's vs mid 40's before pacemaker; just no more increase in heart rate with exercise from before the pacemaker. BTW, is there any time period where that it might take for the CLS pacemaker to kick in assuming it's on? Also, any of you have issues with lead capture issues early on after implant?

Sticky CLS

by Desmodrome - 2021-11-05 08:19:47

I have a Biotronik Rivacor 7 HF implanted in September 2019. I have used the CLS mode with different setting. I have experienced what Biotronik themselves call “Sticky CLS”. I get abnormal high rate of pacing when I’m not supposed to (not active). They tried to reboot the device this spring which helped for about two months, but now the problem is back again. It seems to little knowledge about this issue amongst cardiologists. Also experienced abnormal high pacing rate (“spikes”) when turning for side to side in bed. These spikes are lasts for about 2- 3 minutes before the rate turns back to normal again. These spikes appear with “Resting rate control” being activated. This issue also seems to be very difficult to solve. The local cardiologists say the have “tried everything” and the support from Biotronik representative have not resulted in any solutions. Now they are talking about replacing the device. No one can tell me if this is hardware fault or a software fault on my device only. Is this a common problem which now is solved with a new revision of the device with improved hardware or software?       

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