Exercising with a pacemaker

Hi I am new, 41 year old female, just got approved for a Biotronik pacemaker which will be fitted on 30th Nov. Nothing wrong with my heart itself, but had a brain injury 7 years ago which left me with severe autonomic dysfunction. I pass out and am presyncopal much of the time due to low HR and low BP althouth the latter is relatively normalised on fludrocortisone. 

Exercise has been my saviour since my accident, paradoxically I am more active than before it, and feel best when walking quickly, jogging or riding on my recumbent stationary bike. I believe it helps by increasing my heart rate and BP naturally. I can still mount a reasonable HR response to exercise, it is when I am still my HR tanks and I start to pass out. 

The specialist who recommended the Biotronik felt that it would partially mimic a working autonomic nervous system by giving me a heart rate appropriate to my body position, BP and activity. 

It sounds amazing, but I am just concerned about still being able to exercise to the same level after I have it. I am really encouraged by seeing others still able to exercise but have also read some confusing things about having a maximum heart rate at which it "cuts out" ? which may be lower than I currently achieve at maximal exercise, and also that you cannot use a stationary bike or treadmill as it has to sense you moving forwards in space? 

I would be really grateful if anyone more experienced can explain how it works with exercise. Until I started reading on here I had only heard of quite elderly people having pacemakers who either can't or choose not to move very much anyway. 

If it makes a difference, I will just be paced atrially, not the ventricles as my slow heart rate is sinus bradycardia only, not heart block. My lowest rate captured on the ECG was 38. 

Thanks xxx







Biotronik is an excellent choice

by Tracey_E - 2021-10-26 14:33:19

Unlike Abbott/St Jude and Medtronic who use sensing motion to raise our rate, Biotronik uses a different system that is considerably more sophisticated. It learns you and I believe also uses your breathing. The system is called CLS and maybe someone else can explain it better! But it is one of the very few pacers that will work well for someone who cycles.


There is a function called rate drop response that will prevent your rate from tanking. I use this feature, also. If we are done working out, our rate will come down naturally. However, if we are working out and it suddenly drops, it will kick in with pacing to keep our rate level. 

Expect to take a few tries adjusting the settings to fine tune them to your needs, and for CLS to learn you, but eventually you should be able to exercise as hard as you like. 


by Julros - 2021-10-26 15:59:09

Keep in mind that the pacer does not slow your rate, so if you naturally can achieve a high rate, then you will continue to do so after implantation. 

Many of us cannot go any faster than the pacer will allow due to a blockage of the electrical impulse within the heart. This does not sound like what you are experiencing. 

I personally am much more active since implantation but I did have to push for optimal adjustments, with the encouragement of this forum. Cycling up hills is still a challenge, but in 9 short years, when I am 73, I am sure the technology will change that. 

Biotronik device

by Persephone - 2021-10-26 21:35:39

Thanks for sharing your inspiring story, Daisies.  I also have a biotronik device with significant atrial pacing (plus 100% VP, in my case) and am very pleased with the CLS function - it gets me what I need when I need it virtually all of the time.  Took a little tweaking after implant but well worth the effort. I hope all goes well for you going forward.

Rate dropping & CLS

by AgentX86 - 2021-10-26 23:14:38

Julros makes an excellent point.  It sounds like the purpose of the PM is only to put a floor on the heart rate.  IOW, neither chronotropic insufficiency or heart block are the problem.  The SI node is still intact so it will regulate the heart rate unless it drops below some floor.  The maxmum rate is controlled by the heart, not the PM.  It doesn't seem that rate response (either accelermoter or CLS) is important here.

Low rate

by cardifflass - 2021-10-28 09:47:08

Hi, i have tachy/brady and a dual lead PM.

The PM is set to pace when I drop below 60 bpm, my upper rate is capped by my medication.

I use a rowing machine most days. I'm not a sprinter!

The best think I've found about my PM is that if I sit down in the afternoon or early evening I don't start nodding off!  The weariness I was getting before has gone as well.  

My mum had her PM in her late 70s so it was a bit of a surprise to get it at 64.  She didn't move around much, which as you know is not a good thing.

I'm dead chuffed with mine.


Thanks xxx

by Daisies - 2021-11-08 16:44:23

Thanks for all of your helpful replies, I now feel clearer about what the biotronik will and will not do. I will make sure whoever inserts it is aware of my wish to continue high level exercise, as it is not my own cardiologist who will be doing it. Awesome to hear from other younger more active people with pacemakers xxx 

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I am just now 40 but have had these blackouts all my life. I am thrilled with the pacer and would do it all over again.