For the CLS users

Something interesting for my "CLS buddies":

Spoke to a Biotronik technician today, because I keep getting rate drops while exercising. They either happen in the beginning, or after 20-25 minutes of running. When they happen in the end, the rate will not go up again, no matter what I do. It drops from 160 to around 120, and there simply is no way to increase the rate again.

So, now the tech explained to me that the CLS sensor has a kind of safety feature: If the rate stays at the upper sensor rate limit for some time, the sensor "thinks" that this just cannot be right, and therefore reduces the heart rate. This is based on the presumption that pacemakers are for the elderly people, who are not that active, and who do not or should not spend much time at their upper rate limit. Good news is that this feature can be disabled, but it's not in the settings that the cardio can change; it's in the "expert settings" that are password protected, so you need a Biotronik tech to log in and change this.

Thought I'd share this in case you ever experience similar problems during any kind of endurance training.

The rate drops when I begin to exercise have not been explained, yet. The tech has sent the data from my Polar watch to the CLS experts - who are located in the U.S., not at the German Biotronik headquarters -, and as soon as he's got their feedback, he's going to come to my cardio's office and make some changes to my settings, incl. deactivating the safety feature I just talked about. Hope, I'll soon be rate drop free :-)


11 Comments

Very sad !

by IAN MC - 2015-04-24 05:04:16

Hi Inga Although I am not a "CLS buddy " I do have an interest in the various Rate Response sensors which
are available. I found your post sad on two counts :-

i) why on earth is there still a presumption among Drs and PM manufacturers that you have to be inactive and elderly before needing a PM ? You just have to read the posts on here every other day to realise that this is simply not the case ! It seems to me that a high proportion of PM recipients are particularly active people !!

ii) why on earth are the people who adjust our pacemakers not "expert" enough to be trusted to make every necessary settings change. I just wonder how many of us are living our lives with sub-optimal settings because of this ?

I THINK that in the UK this is not the case with our unique system of having highly trained cardiac physiologists responsible for setting changes but I may be wrong ! I find it appalling that there are secret features on any PM which only the company rep can alter !

I hope that your rate-drop problem is resolved though

Ian

Good news!

by WillieG - 2015-04-24 05:04:56

Thanks for sharing your info about the safety feature. Too bad it is password protected and will take longer to correct. Interesting how pacemakers seem to put inactive people first.

I am interested in the the of Polar monitor you have that stores data. Mine only records the upper and average HRs. It might be nice to have a graph to explain what happens. After my recent change if settings, I am still experiencing what feels like the start of a block. When walking, I see my HR drop to zero for maybe 3 seconds and then back up when I feel this uncomfortable sensation. I just returned from a bike ride where I felt the same strong beat, but the monitor did not show a drop. So a monitor with more stored HRs might be helpful. Another PM friend uses a Scosche Rhythm arm band that transmits to a Garmin watch. I am still gathering info.

I hope you get your settings changed soon and can run for a longer time at the HR you need! Let us know!

Polar monitor / expert settings

by golden_snitch - 2015-04-25 01:04:05

Hi!

Willie, the Polar I am using is a RCX 3. It comes with a cheststrap, a stride sensor (runners can put in on their shoe, it measures distance, pace etc.), and something that looks like a USB stick and is called "Polar Data Link". When you're done with your training, you put the stick into the USB port, put the monitor next to it, press the "synchronize" button, and then the data is uploaded to the polarpersonaltrainer.com website. There I can see my heart rate curve, pace, and so on. And these data I can share with other people, there's a link I can give them. An alternative to this are all the different activity apps you can download on your smartphone. Many of them can be combined with a cheststrap, too. But I never run with my smartphone in my pocket.

Ian, totally agree with you on your first point. I don't get it, either. And I'm telling the techs and cardios who say such things that they are wrong - again and again and again. I have even heard questions like, why I want to run longer distances, and been told that I should be happy that I can run a bit at all. So fed up with this!

Regarding your second point, well, CLS is a bit special. This is not standard for all rate response sensors. The expert settings are really expert settings, not even the head of technical service of Biotronik knows them all by heart, that's why he gets in touch with their CLS experts. They are not explained in the 300 pages manual I have for my pacemaker. So, I think, it's good that they are password protected, because otherwise some cardio would probably mess around with them. My experience is that many cardios are not familiar with the CLS sensor, so it's definitely better to have the techs change the settings. I'd doubt that even your cardiac physiologists would know what these expert settings are about. They usually only know what's in the manuals. Biotronik says, these settings are very, very rarely changed. Usually, the settings the cardio can change are totally sufficient.

Inga

Data

by golden_snitch - 2015-04-25 03:04:03

Here's the data from my Saturday morning run:

https://www.polarpersonaltrainer.com/shared/exercise.ftl?shareTag=347912c9e51de70e445bcd34b5fa17df

Good to know....

by Jackw - 2015-04-25 07:04:07

GS:

I am going to take your post to my visit with the tech at the pacer clinic when I have my first check up post implant in two weeks. I am hoping to get some jogging in this week to get my rate up to see how CLS reacts.

Good to have someone with such good access to the technical people at Biotronik!

Thanks again!

Jack

Good to know....

by Jackw - 2015-04-25 07:04:35

GS:

I am going to take your post to my visit with the tech at the pacer clinic when I have my first check up post implant in two weeks. I am hoping to get some jogging in this week to get my rate up to see how CLS reacts.

Good to have someone with such good access to the technical people at Biotronik!

Thanks again!

Jack

Data

by WillieG - 2015-04-25 08:04:42

Thanks to the link for your data. I am assuming the red line is your HR as I saw it drop from the 160s down to 120. What is the black line? Very nice to have as you can show to your doc.

Ian....I do not have Chronotropic Incompetence so I can't give you any info on Boston Scientific's Rate Response. Sorry I didn't get back to you! Maybe the CLS system is better if you can get the settings correct!

Leaving rain and sleet in Ohio and headed to sunny California!

Curve

by golden_snitch - 2015-04-25 10:04:31

The black curve is the pace measured in minutes/kilometre. The line looks a bit like it's very unstable, but when you take a closer look you see that it's pretty stable, somewhere between 6'00 and 6'60.

You're making me jealous, Willie, I love California! Unfortunately, it's a 12 hours flight away :-(

Rate drops

by Stillrunning - 2015-06-23 11:06:44

I have similar issues with my Medtronic Adapta device, sometimes after starting a good run somewhere around 12 to 20 mins my HR drops from 150-160 to 90 to 100 and will not raise even tho the perceived effort is like I've speeded up or going up hill, if heaven forbid I walk for a few secs it takes me the next three days to work it out of its change in mode or pacing adjustments. Also sometime times I go out to run and my heart rate won't raise above 100 no matter what and my upper tracking rate is 149 and upper sense rate is 160 in DDDR mode

Rate drops

by Stillrunning - 2015-06-23 11:06:56

I have similar issues with my Medtronic Adapta device, sometimes after starting a good run somewhere around 12 to 20 mins my HR drops from 150-160 to 90 to 100 and will not raise even tho the perceived effort is like I've speeded up or going up hill, if heaven forbid I walk for a few secs it takes me the next three days to work it out of its change in mode or pacing adjustments. Also sometime times I go out to run and my heart rate won't raise above 100 no matter what and my upper tracking rate is 149 and upper sense rate is 160 in DDDR mode

sorry for digging up old thread

by green18 - 2016-10-27 16:19:44

Was there ever an update that explained the safety feature kicking in at the start of the run?  Is the disabling still an "expert" feature?

All of this would perfectly explain some of my difficulty trying to jog (I have a separate thread about this) and if this is an option I have to think I would be better off long-term using CLS vs the accelerometer.  I do believe i need support on the ramp-up during vigorous exercise as I was having difficulty on exertion pre-PM.

This is invaluable information for me to have on a future visit and I might want to request a rep available when I go in if this is the case.  Thanks much!

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