Best Pacemaker for a bicyclist

I have been an avid bicyclist for years. Recently, my cardiologist implanted a Medtronic monitor in my chest to determine whether I need a pacemaker. (I have had bradycardia for many years and had an ablation for A-Fib back in 2014.) Long story short: a few days after the implant, I received a phone call from the Cardiologist's nurse who told me that the cardiologist wants to meet with me on Tuesday, to discuss pacemakers. The cardiologist believes that I have sick sinus syndrome and the monitor revealed compressions (during rest) every two seconds. Some compressions were 3.5 seconds apart. So, I think it is evident that I probably need a pacemaker. My question is this: In view of my biking (10,000 or more miles per year), is there one pacemaker that is better than another? I understand that Boston Scientific's pacemaker is activated (at least in part) by respiration, but that Medtronic's is activated by motion, and that Medtronic's pacemaker is not that great for bicyclists. Does anyone have any experience or recommendations they are willing to provide? Any input is appreciated. Thanks!



by AgentX86 - 2021-06-26 14:17:32

"Compressions" don't make much sense.  Do you mean "pauses", where the heart stops beating for a period? If so, two seconds apart means a heart rate of 30bpm.  That's a pretty bad Bradycardia and probably deserves a pacemaker.  Pauses of 3-1/2 seconds aren't as worrying.  Anything over five gets their attention.  IME six will get your attention!  ...and send you scurrying to the ER.

I don't have any experience with Boston Sci pacemakers.  I have a Medtronic but you're right.  Medtronics aren't real great for exercise where motion can't be detected or where more exertion than normal is required for the motion sensed.  I've found that particular problem climbing stairs or moosing around a wheelbarrow full of dirt.  The motion sensor just says that I'm walking so doesn't give the kick needed, though I may be panting from the exertion (and lack of oxygen).

I believe you're right.  A Boston Sci pacemaker may be your best choice but you may not have much say in the matter unless you want to change doctors.  Supporting one manufacturer takes a lot of infrastructure, training, and ongoing cost.  In addition, the manufacturers support their customers and their patients with on-site specialists who can help with the hard cases.  Spending the money to support two manufactuer's isn't likely.

Add to that, some hospitals are large enough that the manufacturer's rep works on-site.  He's paid by the manufacturer but works on the customer's site and supports only that customer.  To get this level of support (and pricing) the hospital has to sign an exclusive contract with the manufacterer.


pacer for cycling

by Julros - 2021-06-26 15:32:38

Be aware that not all Boston Scientic devices have minute volume capability. I wish mine, that was implanted 2 years ago, did. The pacer rep says he has optimized all my settings, but even so, I do not detect an increased heart rate when going up inclines, leaving me huffing and puffing on climbs. Otherwise, my heart rate is around 100-110, but then again, I am a more casual cyclist: 2-3 times a week for about an hour each time. When I jog, watch says my heart rate goes up to 155, my max setting. And yes, I realize, that watch readings are sketchy at best. 

I'm biased...

by crustyg - 2021-06-26 19:01:38

I'm a keen road cyclist.  The BostonSci Accolade that I have (for SSS+CI) is, arguably, the best PM for a road cyclist with my condition.  It needs to be tuned for the individual (which mine has been), and is one of only two vendor PMs that can provide adequate Rate Response for road cycling where there isn't adequate upper body movement to stimulate the accelerometer that pretty much all PMs have - it uses Minute Ventilation (depth of each breath * breaths per minute).

I've recently posted in answer to the Q 'How does MV work' if you're interested.

I was very lucky: my EP-doc normally implants Medtronic, but he listened to me (wittering on about road cycling) and selected BostonSci Accolade for me.  He *hated* implanting the BostonSci leads (didn't think that they were as easy as Medtronic to implant, and as I was fully awake during PM+leads implantation I could hear all of the soft cursing).  But everyone likes what they are used to and pacing leads are no different.

My PM is great for running, great for road cycling and only OK for swimming, Yoga+Pilates.  There's no PM that's perfect for everything if the SA-node has failed and the patient is athletic.

Hope that helps.


Boston Scientific

by JWren - 2021-06-26 20:19:25

I had a Medtronic implanted 12/18 after being told I would get one that would sense respiration.  I broke a lead in April and have had a new PM from Boston Scientific for about a month.  (I got rid of the cardiology outfit that put in the Medtronic.) I am primarily a swimmer but biking is part of my overall mix.  I am 72 and have been averaging in the 13s for mph for about 5 years.  My last 5-6 rides (15-18) miles have all been in the 14s. So my B.S. pm is definitely better for biking.  Still working on the swimming.

Go for the Accolade

by Mike417 - 2021-07-02 14:34:49

I second what Crustyg said.  I have an accolade, and it does the job.  I am an avid photographer and hiker.  Having the MV capability gets me up hills, and keeps going for the distance.

My first EP doc told me all PM were the same, NOT!  He put in the Medtronic Azure, and I had a lot of trouble with endurance, and going up hills.  My road has several hills, so walking our neighborhood was exhausting.  I complained loudly, and they swapped it out for the Accolade.


Definitely Boston!

by PacedNRunning - 2021-07-05 04:19:59

I'm a runner. I don't use the accelerometer or MV because my own heart is able to increase on its one. My ventricles just follow the beat of the top. But my doctor picked Boston in case in the future I needed the MV. I also cycle but not as much as you do. :). I would definitely go for Boston if you cycle as much as you do! Best of luck. 


Pacemaker for cycling

by Alphakiwi - 2021-07-11 03:48:35

I have a Biotronic dual chamber Model Edora 8 DR-T.  I have it only 5 dsys now so no idea how it goes when cycling. Im an ex competive cyclist. Not intetested in competing now but want to get out with club rides. I believe its rate senstive. My EP is a cyclist so heres hoping

Best Pacer

by Stache - 2021-07-20 23:25:27

All of us have an opinion I have an Abbott Pacemaker (St. Jude Medical) PM2272 dual chamber for my 3rd-degree complete heart block.  I had no choice what was implanted at the time.  I ride a mountain bike and ride hard all the time.  To my surprise, my pacer senses my muscle requirements and speeds my heart rate up automatically from 60 to as much as 140 bpm.  Because my heart's lower chamber is so large I can beat at a lower rate and still get 100% 02.  The highest I have recorded is 90 bpm riding for 3-hours.  I do have device performance daily with automatic remote monitoring and my doctor has monitored me on a couple of my long hard rides.  I only started riding again on June 1st after my heart attack on 02/08/2021.  My doctor tells me to push it as much as I can stand.  Right now 3-hours on the bike is what I can take, still concerned but the monitoring says I am good to go longer rides like I used to take.  However, I lack the confidence to push it.

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