Help with pacemaker selection for cycling

Hi, I'm trying to help my brother who has bradycardia and sick sinus syndrome.  He is also in a-flutter.  He had an ablation for a-fib about 4 years ago and now needs a pacemaker.  He is 66 and is an avid cyclist, he goes mountain bking up very steep trails.  He wants to keep riding until he absolutle cannot.  His doctor has told him he will put in whatever pacemaker he wants.  He is considering Biotronik or Boston Scientific.  Two of the doctors he has seen have recommended Medtronic.  He likes the Biotronik and Boston Scientific because of the way they claim to respond to the heart under load.

Does anyone have any experience with these two brands and cycling or exercise?  I've tried calling each of the companies to speak to a technician but have not been able to do that.  All I've talked to is the person who answers the phone.  Everyone has been really nice, but I think my brother needs real life information from people and I thought this is the place to get that.

Thanks in advance for reading this post.



Cycling fan also

by Katja3 - 2021-03-06 16:07:45

I have had Medtronic for 5 years and I'm now on Biotronic since year ago, and in my experience both work equally well.

I think with active sports just check that the model he chooses allows him to go as low and as high as he needs, so that after he has recovered from the surgery they can adjust the min and max rates to allow him to enjoy his hobby.

A lot of the responses can be modified by a skilled electrophysiologist. Typically if the pacemaker is blocking exercise its because the settings are not right, and many times you need to book an appointment with an actual specialist rather than typical pm check clinic that typically less geared for athletes. 

Device company doesn't matter, the device clinic DOES

by Pinkit94 - 2021-03-06 16:37:10

I am an avid cyclist, both road and mountain. The brand of the device does not matter as much as the programming of the device. Make sure that the device clinic is well aware of his active lifestyle because they can turn on/off certain features that can help him reach his cycling goals. Some clinics are not used to active patients, so advocating for yourself is crucial! Btw it took me about 4 months to get back to light riding and about a year to get back to mountain biking. Best of luck!

PMs for Cycling

by IAN MC - 2021-03-06 17:14:43


Hi Debra   I do wish that I'd had you as a sister researching pacemakers for me before I had  to choose the best one for cycling.

Your brother is absolutely right in trying to ascertain "the way they respond to the heart under load " because all three  makes are  different ! 

Like me , he has bradycardia caused by sick sinus syndrome so chances are that he suffers from " Chronotropic incompetence " which means that his heart rate will not respond to exercise the way it should.... so he will get more breathless than he should when he cycles up those steep hills . This is where the Rate Response function of the PM comes in.

To respond to exercising  the pacemaker has to know that you are exercising,  All 3 have sensors to detect exercise ;  all 3 have different systems :-

MEDTRONIC : Relies on a single sensor known as an " accelerometer " . This sensor detects motion / vibration in the pacemaker and raises the heart-rate accordingly, The trouble is that when you cycle , there is very little motion in the upper chest unless you are on  a very rough surface. I would definitely avoid the Medtronic .

BOSTON SCIENTIFIC :  Has 2 accelerometer and a " minute ventilation" sensor which measures increases in your breathing, Cyclists who contribute to this forum all seem to be pleased with their Boston Scientific PMs.

BIOTRONIK : Has a unique  "CLS sensor." which measures the  contractions in  the heart muscle and alters the HR accordingly. It claims to be the most physiological but some cyclists have reported inconsistent results.

All 3 will manage his bradycardia equally well but there are definite differences when it comes  to their Rate Response functions. Those differences will become evident when your brother is mountain biking.

It is possible that Katja and Pinkit do not need Rate Response.

I hope he makes the right choice




For road cycling Boston Sci

by crustyg - 2021-03-06 17:34:42

For road cyclists with SSS+CI, I don't think any PM with just an accelerometer will do - there just isn't enough upper body movement for the accel to drive RR to a sensible level.

Anyone who claims that their PM can increase HR based on heart contractions is selling snake oil.  Just think about this: SSS+CI, so the HR is at the rate that the PM sets.  The PM can't 'notice' anything different about heart contraction because only the PM can increase the HR!  It's theoretically possible for the PM to detect the strength of heart contraction (mediated by sympathetic nerve supply) but I can attest that when I want my HR increasing I only get upset (=>increased sympathetic drive) when my PM doesn't get me there quickly enough as it takes 2min from near resting - around 60BPM for me - to maxHR.

So, for road cyclists with SSS+CI (and pretty much everyone with SSS has CI) the best choice is BostonSci.  You MUST get the MV calibrated properly: I spent an hour on a static bike with BostonSci rep and EP-tech tuning mine.  Mountain bikers tend to have more upper body movement, so I can believe folk who say that suitable tuning of a non-MV PM works for them.

But, of course, this is only my opinion, based on nearly 2years of experience of road cycling with Accolade.

Thank you all so very much

by Donna49 - 2021-03-06 18:53:05

A huge thanks to everyone to responding to my post.  All of your great information is a tremendous help to my brother.



thoughts on Biotronik

by Tracey_E - 2021-03-07 11:43:29

CLS is the trickiest to program and it has a learning curve as it gets to know us. I would only go with that one if the doctor has a lot of experience programming it. 

Definitely not Medtronic or St Jude/Abbott, they are accelerometer only. 

And don't forget Debra . . .

by Gemita - 2021-03-08 05:15:32

in all your excitement to find the right pacemaker and to get those adjustments just right for your brother, there is still one outstanding problem - the Atrial Flutter!  Flutter can be fairly easy to treat (cure) so your brother may need to go back to see his EP again for another ablation?  Your brother and any new pacemaker will certainly be able to work better without the Atrial Flutter

Atrial Flutter treatment

by Donna49 - 2021-03-08 10:16:18

Thanks Gemita.  He was first told they could ablate the atrial flutter when they put the pacemaker in.  Then the doctor told him it would have to be done with a separate procedure.  He's now seeing another doctor because each one only wants to discuss with him the PM they prefer.  So far that has been Medtronic.  We found several doctors that use the Boston Scientific, which is the one he is leaning towards.  

pacemaker for cycling

by bab - 2021-04-04 00:05:56

Agree with comments above  - very important to have a technician tune it to your needs.  Can recomend Boston Scientific.  Have had a K 185 for about 6 years and heart rate stays up very well on road cycling and trails so can recomment that with the accelerometer and the minute ventilation. Prior to the BS had a Medtronic but that just had the rate response and for some reason did not work anywhere near as well for cycling as the BS.

Reiterate the key though is the work of the technician in tuning to your needs and that takes an bit of ttial and error.



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