Best pacemaker brand for athletes?

Follow on question to my inquiry below.  

I am going to need a new pacemaker this fall.  Which manufacturer has the best pacemakers for use by athletic types?  They are like any other product, with differences in software and firmware, so I assume one brand may be better than the others?  Is this true?  I'd be curious to know which one.


Best pacemaker

by AgentX86 - 2021-04-26 22:48:22

What sports?  Why do you have a pacemaker?  There is no "best".  It's hard to know what's important to you without any information.

It's as much about the tuning as the make/model

by crustyg - 2021-04-27 03:17:09

You say that you are a cyclist. Road cycling is a challenge for those who need a PM with RR (commonly SSS+CI), because the accelerometer in models that support RR doesn't detect enough upper body movement to drive the RR algorithm.

There are only two PM vendors who have models that support Minute Ventilation, and arguably the BostonSci Accolade is the best of these models - but you still need it properly tuned to be effective.

Regardless of which make/model you have, the difference between the OOTB manufacturer's settings and properly tuned for you and your activities is like chalk and cheese.

I get the impression that models that claim to auto-tune themselves don't deliver very good results: if you look at the market the vendors sell into (the EP-docs, not us, the patients), the thing that EP-docs hate is spending a lot of time fiddling with the settings, i.e. tuning a PM.  It's time-consuming, expensive, needs gym kit in a resuscitation setting and requires an EP-tech, manufacturer rep, and, notionally, the EP-doc as well to provide legal cover. And will take about an hour with you on a treadmill or static bike.  So some vendors claim to do away with all of that with auto-learning software.  I don't buy it.

Mine does a really great job for road cycling, running, OK job for Pilates+Yoga classes, but not a great job for swimming.  Very good overall but not perfect.  I don't think any PM will be perfect until we, the patients, can change between two settings depending on our planned activities.  But this won't happen in my lifetime, not because the tech isn't there - it's trivially simple - but because the primary customers, the EP-docs, don't want it.

av block

by Tracey_E - 2021-04-27 11:11:41

I see from your other post you have av block but have had trouble fine tuning the settings. Do you know if you have anything else going on? AV block is generally an easy fix, doesn't take much more than figuring out your upper limit. 

Do you know if you even pace atrial? Most differences between devices are in the rate response, which is atrial pacing and may not be relevant to you. In theory, we don't need rate response with av block and any pacer should be able to do the job just fine. 

The device is only as good as the doctor programming it. I know someone who switched from Boston to Medtronic, not because the Medtronic was better but because she lives in a small town, the local Boston rep wasn't good, and her doctor knew Medtronic better. 

(Edited because sentences were all missing so it didn't make any sense)

More on the topic....

by airwayotto - 2021-04-27 13:11:26

Thanks all for your answers and feedback.

To AgentX86, I am a 67 y.o. bicyclist but I also hike hills and ski and I am a generally active guy.  My focus is on making road cycling comfortable and fun.  I also do not expect miracles and understand the need to sort of work with my pacemaker and its multiple settings and variables.

To Crustyg, it sounds like your experience almost exactly parallels mine.  I was going to send a private message but then no one else would benefit from our experiences so I will continue here, for now.

I have been paced since 2007 and about to receive my 3rd PM.  I was "shopping" as I like to participate in decisions made by doctors.  I know of MV and the accelerometer systems in the PM and use both.  I am unaware of the learning software Crustyg refers to but will look into it.  I understand that these things are marketed to docs, not patients and yes, having a way for users to switch modes on the PM would be awesome.  In any event, I think sticking w/ Boston Scientific makes sense based on this input and my doctors preferences. 

Over the past few years, I have been in and out of my doc's office, working with techs to get things right.  They were OK for a year or so and then I developed atrial flutter and things sort of went sideways. 

Problem always gets down to the fact that the doctors won't spend the time and there are intense politics when you involve multiple people.  In the past, I have also called Boston Sci and talked to then (within their limits, they were great and informative) and they provided some guidance I could pass on.  I have never been able to get someone to spend an hour with me on a bike or even look at my Strava data (not perfect but useful), which I think would really help.

My other inquiry to Pacemaker Club was to see if there is a local doc office in Northern CA where someone has taken an interest in this whole topic and might be willing to facilitate the process of getting it right.  Sports and cardiology often go together.  Alternatively, how do I find a local Boston tech that I can request who has deeper experience or training?  Finding the people with the experience and patience and interest is  what I really need. I’d be happy to change practices to get this attention.

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