Rate response problems with Medtronic Azure pacemaker while cycling

   I am a 69 year-old experienced male cyclist, having ridden for over 35 years.  I began cycling after experiencing a hip injury that still prevents me from running.  I always ride with a chest-strap heart rate monitor.  Around 12 months ago I began experiencing fatigue, dizziness and low heart rate while riding, occasionally at first and then with increasing frequency.  I was eventually diagnosed with sick sinus syndrome/bradycardia, and had a Medtronic Azure dual-lead pacemaker implanted a little over six months ago.  It's my understanding that the Medtronic Azure uses a single rate-response sensor based on accelerometer technology.

    Soon after I started riding again after implant surgery I noticed problems with rate response, particularly on long, slow climbs requiring a lot of effort, but where apparently there wasn’t enough upper body movement to trigger the accelerometer to increase my heart rate.  Over the course of several months I made several trips back to my surgeon to discuss these problems, and the sensitivity level of the pacemaker rate response was adjusted upward each time.  After each adjustment  my rate response seemed to improve for awhile, but I eventually encountered episodes of low heart rate in situations such as climbing.

    At this point the sensitivity of the rate response sensor is at its highest setting, and I am still occasionally experiencing situations while riding where my heart rate is too low to support my level of effort.  I’ve discussed the problem with Medtronic, and they acknowledged that rate response during cycling is particularly problematic for their accelerometer-based rate response sensor technology.  I’m beginning to think that the Medtronic pacemaker with its single-sensor accelerometer technology is not appropriate for cycling activities.  I plan to see my surgeon again to discuss these issues, but I want to do my homework first so that we can have an informed and useful discussion.  

    My question is this: are there pacemakers out there that use rate response sensor technology more appropriate to cycling?

11 Comments

The following links may be of help

by Gemita - 2020-10-03 09:09:31

Hello pacemakercyclist,

While you wait for responses from other cyclists, the following fairly recent threads might be of interest.

https://www.pacemakerclub.com/message/37472/hr-dropping-while-on-climbs

https://www.pacemakerclub.com/message/37482/long-term-effects-of-more-sensitive-rate-response-pm-settings

You can also try searching the PM site under "Q".  Lots of good Rate Response posts.  Here is Page 1 link

https://www.pacemakerclub.com/search?page=1

 

Pacemakers and Cycling

by IAN MC - 2020-10-03 10:19:58

There are 5 major brands of pacemaker :-

Medtronic, Boston Scientific,  St Jude, Sorin  and Biotronik.  All 5 perfectly manage bradycardia which is the main reason we have pacemakers but some are better than others when it comes to cycling if you need Rate Response.

Medtronic and St Jude have single "accelerometer" sensors to detect exercise...  they rely on measuring changes in body movement . But they are hopeless for cycling because the upper body , where the PM is situated hardly moves when you're on a bike... so your exercise is not translated into the need for a higher heart-rate.

The best makes for cycling, without any doubt, are Boston Scientific and Sorin. They both have dual sensors ... one measures movement / vibration; the other measures changes in breathing. Cyclists implanted with these 2 makes seem to be happiest with the results

The 5th make, Biotronik, uses its own unique CLS sensor which sounds good on paper but cyclists have reported very variable results with it.

One massive problem is that if your EP fits you with  the wrong PM, you tend to be stuck with it for 10 years ! That has happened to me ..I also have a Medtronic.

Best of luck

Ian

Insurance coverage

by pacemakercyclist - 2020-10-03 10:52:34

"One massive problem is that if your EP fits you with  the wrong PM, you tend to be stuck with it for 10 years ! That has happened to me"

Thanks Ian.  I've wondered about a do-over, and if there is any way I can get Medicare to cover it.

Who will pay for it ?

by IAN MC - 2020-10-03 11:01:10

I am in the UK,  I see you're in the U.S so sorry I can't help you on the Medicare issue.   I decided to live with the Medtronic for 10 yrs and will ask /plead / beg for a Boston Scientific or Sorin at replacement time.

........ but the Medtronic ain't all bad ..it's only bad for cycling !

Cheers

Ian

........ but the Medtronic ain't all bad ..it's only bad for cycling !

by AgentX86 - 2020-10-03 12:22:57

No, they're worse for swimmers.

No, you're not going to get Medicare, nor any insurance company, to pay for a generator change any more than you're going to get them to pay for a nose job. It's not medically necessary.

No, you're not going to get Medicare, nor any insurance company, to pay for a generator change any more than you're going to get them to pay for a nose job. It's not medically necessary.

by pacemakercyclist - 2020-10-03 13:24:00

You're probably right, but I'm going to explore the possibility, once I get some information on what would be a more appropriate PM,  My argument would be that it is medically necessary to replace it because it's inappropriate for cycling, which is the only form of aerobic exercise I can do because of my inability to run. 

Yes you can

by Mike417 - 2020-10-04 02:19:43

I had the same problem with my Azure, but while hiking.  I could not go up hills even on the most sensitive settings.  When going up hill hiking, and with a 35 lb pack, you are on the front of your foot.  No vibration to activate the sensor.  I complained to my doc, and insisted it be changed out to a Boston Sci. PM.  They did that last year with almost a year on the Azure.  We had to pay only out of pocket.  I would no back to the EP doc and tell him you are extremely dissatisfied, and insist it be changed out.  They try to get you to live with it, but not doing activities you love is not living.  I love the BS PM.

Don't delay!

Mike

Rate Response problems with Medtronic Azure

by frankmcw2 - 2020-10-10 01:51:25

It is true that the Medtronic PM can be difficult to adjust to deliver adequate pacing for such activities as cycling, mountain climbing, etc. I have a Medtronic Advisa (with duel leads and an accelerometer) that took me over 2 years to find an adjustment that works well for those activities. Since there was no way I was going in for another surgery to change out my Medtronic PM for another make, I was lucky to find a Medtronic technician who has developed a working solution for many athletes in the Phoenix area. I have outlined the specific adjustments that can be made to upgrade the pacing response for a Medtronic PM in a pdf file. From the comments posted above by PACEMAKERCYCLIST it sounds like this adjustment may greatly improve your cycling experience. Send me a message on this blog or send an email to paulafrankmcw@gmail.com and I will return an email with the pdf attached. 

Please send me your recommended Medtronic settings

by pacemakercyclist - 2020-10-15 07:45:52

frankmcw2; thank for the above information.  I'd like to show my local PM tech the settings you have developed for your Medtronic that seem to help you.  I sent an email to your address, and I'd really appreciate it if you can send me your settings.  Thanks.

Rate Response problems with Medtronic Azure

by Keckert1 - 2022-08-04 13:28:02

Hi all, I'm new to this forum and late to the conversation but came across these posts while doing research for the same problem.  I just sent an email to frankmcw2 for the PDF file mentioned but was wondering if anyone else made those same adjustments and what your results are.  Also, is anyone on this form living in Europe (Spain specifically) and have you found help here?

Thanks!

Replaced MDT Azure with Boston Sci Accolade and couldn’t be happier for all endurance activites.

by Endurance_athlete - 2023-02-07 17:10:21

I am a 59 yo female endurance athlete diagnosed with chronotropic incompetence and received a MDT Azure pacemaker on Sept 19.  After 4-6 weeks of recovery, I started testing it and found it did nothing for any sports except running.  As others explained here, the accelerometer is only triggered during a certain vibration - during running it's from the foot strike.  The device cannot differentiate between uphill or downhill - just increases to the max setting about 2' after start and stays there.  However, there was NO response during cycling (mountain biking, gravel, road, fat biking or indoor trainer), lifting weights, hiking, cross country skiing (classic or skate).  I was devastated as I had a lengthy conversation with the EP about my desire to return to these activities.  After completing research and searching for another EP, I had a generator redo on Jan 11 with the Boston Sci Accolade.  Both the EP (Dr. L. Amado) and the device tech from Boston were fantastic and are based in Minneapolis.  I have evaluated it during all activites listed above and couldn't be happier.  My HR is back to a normal response due to the Right Rate feature (Minute Ventilation) only available in the Boston Sci Accolade family of pacemakers.  Their website includes a claim that it is the only device to restore chronotropic competence.   I found some additional studies on PubMed as well that showed the MV technology provides a physiological response.  The current settings were set the day of the procedure and seem to be dialed it.  I am EXTREMELY SATISFIED.  For me, the redo was totally worth it.  I can't imagine not doing the activites I love to do.  

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