Accelerometer v Minute ventilation Rate Response S

rdman in a recent post touches on this subject and I don't have the background knowledge to add anything useful to golden_ snitch's comments but I do have a great interest in the choice of Pacemaker for active people

- I am very active as a runner and cyclist and currently have a Medtronic Advisa

- because I am fed up with having to tap the PM / stand on the pedals etc when cycling because of the limitations of the Medtronic accelerometer , I am thinking of switching to a Boston Scientific to enjoy the more physiological minute ventilation sensor.

- switching a PM before the battery has expired is obviously a big decision so I want to know from anyone :-

Just how good is the minute ventilation sensor for cyclists ? Is it slightly or considerably better than the accelerometer sensor ? ( I do realise that both are used together ) . Does it feel as good as your heart did before you ever needed a PM i.e. is it completely physiological or is it just a marginal improvement over an accelerometer sensor.

Also , are the two-sensor PMs intrinsically more difficult to optimise the settings ? Would I expect a period of grief before getting both sensor settings optimised for my active lifestyle ??

Is it worth going through all the hassle of a second implant procedure / another recovery period / risk of infection etc etc so that I can cycle more easily. Just how good is the dual sensor system in the Boston Scientific PM ?

Any experience-based comments would be greatly appreciated

Thanks

Ian

9 Comments

Rate response

by golden_snitch - 2015-04-13 03:04:02

Ian, as you might remember, I never had a Boston Scientific pacemaker. Sorin is offering rate response with accelerometer + minute ventilation, too. I had the Sorin Reply DR, and that was not difficult to optimise. It didn't give the cardio too many options. The automatic optimization, with two sensors switched on, worked really well. The leading sensor was the minute ventilation sensor, and there was a cross-check between the sensors to avoid inappropriate responses (one sensor detecting something, the other not).

I know that in the BS pacemakers with two sensors, you at least have loads of different choices, and can program each sensor individually. But I'm quite sure that they also have some kind of automatic optimization that you can activate and that optimizes the interplay of the two sensors.

If you do love cycling, I'm sure the accelerometer + minute ventilation sensor is an improvement for you. And even if it does take some time to optimize the settings, it should be worth it. CLS also works well for cycling.

No rate response sensor is as physiologic as a functioning sinus node. You always have to compromise.

Hope this helps a bit. I'm curious to hear from folks with BS pacemakers and both sensors switched on, too.

Thanks Inga

by IAN MC - 2015-04-13 03:04:15

Yes your comments ,as always, have been very helpful.

I had forgotten about the Sorin option . I am having a PM check-up next month so will discuss exactly which dual-sensor PM models are readily available in my local hospital and will also ask if any new models have appeared on the market.

Ian

There is just...

by golden_snitch - 2015-04-13 03:04:40

Sorin and Boston Scientific offering this combination of sensors, and then there is Biotronik with CLS sensor. Sorin is also great, because their pacers are so small :-) Medtronic and St. Jude have all accelerometer only. No new models, no further advancements with regards to rate response. When I did lots of research before I got the CLS device last year, I asked all manufacturers about their plans with regards to rate response - no innovations, everyone is happy with what they already offer :-(

Good luck with your appointment!

IAN MC....wow..wow.wow.....

by Tattoo Man - 2015-04-13 06:04:40




.................slow down Dude..

Stop messing with science that you have no idea about and take up something less stressful...

Like a bit of a game....

Something that gets you out into the fresh air,..without getting you all puffed...??

I have it on good advice that the game of Golf rivals Snooker / Pool and Darts as the game for the ancient and totally past it..

IAN,..old pal,..... do not thank me...it is the least that I could do for my Geriatric Twin.

TM

Difficult Decision

by WillieG - 2015-04-13 10:04:14

I have Boston Scientific's Advantio PM for exercise induced 2nd degree block. The Minute Ventilation was on at the beginning although my sinus node is fine. I still was not being paced when I felt a block biking uphill. When these blocks occur, I feel a very strong heartbeat, which is not a pleasant feeling, and notice my rate goes down to about half for 30 sec or so. I went back for 2 adjustments. After the second , I was pacing 69% ventricular. Went to the Cleveland Clinic and they turned Rate Response off and the AV search + to on. After that I had zero pacing and still felt the discomfort during a block. Then my blocks sorta went away from once a month to "none" for 3 months. The good news ended in late March and now the blocks occur at a rate of 130 versus 150 or 160. I am scheduled for a treadmill test this Thurs and they want to check me for Chronotropic Incompetence, which I think is odd. Hopefully, they can find a setting to pace during a block without excessive pacing, which hasn't happened in the 10 months that I have had this PM. I will let you know if they turn the minute ventilation on and how it goes. Personally, I would hesitate to go thru another surgery without knowing for sure that this would work for you. Are you not able to get your HR up and feel like you can't get enough oxygen or do you have blocks? Just curious...

Good luck with your decision!

No blocks !

by IAN MC - 2015-04-14 04:04:26

Hi Wilma Thanks for your comments . Just to clarify things

I have Sick Sinus Syndrome and have not experienced blocks but I do have Chronotropic Incompetence.

Because my heart rate doesn't increase as it should when I exercise I quickly get out of breath and have to stop. I notice it most when I am cycling ,particularly on long hills, I find that tapping vigorously on the PM site persuades the Rate Response to put in extra beats and it helps, but it is not like the real thing ( the real thing being a sinus node which works properly )

I can still moreorless run and am in a running club but the chronotropic incompetence doesn't half affect my speed and stamina; dammit ! This is why I am thinking about changing my PM to a more exercise-friendly model.

I sometimes wonder if exercise is good for us . In your case it triggers off heart blocks, other people have exercise-induced hypotension , I have exercise-induced oxygen deprivation !

I hope that your treadmill test solves your problems

Maybe Tattoo Man is right and I should stick to golf where, incidentally, I suffer from a totally different type of Incompetence.

I am beginning to worry about you Tat Man . You have started calling me " Dude" . Have you been watching too many American movies ? You will be carrying a gun next ( I bet that would make you stand out in Newark )

Cheers

Ian

IAN..Old Dude Chap........

by Tattoo Man - 2015-04-14 05:04:18


....................









................how very portentious of you !!

FACT...last evening Mrs TM and I attended a red carpet event at the Palace theatre in Newark as part of the roll out for the National Civil War Centre,..about to open to the public on the 3rd May..

Mrs Tm will be a Room Guide at the museum.

I may well be found on the 'Queens Sconce' ,..along with 5000 battling Royalists and Parliamentarians on the 3rd May.....SO.....spot me at the frontline with my big floppy hat and smokin' musket

Yup, Dude...Tat Man will be 'totin a piece' in the hoods of Newark in just a few days.

'Back at-cher' Twin Bro

Da Tat Dude














Which of the many...

by donr - 2015-04-14 10:04:44

...Newark's, Tat?

There are at least 4 in the US - New Jersey, Delaware, California, New York. Dunno how you pronounce yours, but in New jersey, it is commonly called "Nerk." In Delaware it is officially New Ark.

I guarantee you that you would not look out of place packing heat in New Jersey or Delaware. Floppy hat included....Dude! Bible optional in those states.

Don

DON, DON, DON.........

by Tattoo Man - 2015-04-15 03:04:07


...............there are 39 'Newarks' in the World at the last count...I happen to live near ( 2 miles away) from the real, original, back to the bronze age Newark......

I am also only about 90 minutes from Boston..a place little known outside the UK, but where some years ago was a place of major exportation of bibles and floppy hats..plus the odd musket for those heading towards Georgia..

Best wishes

TM UK

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