Boston Scientific Accelerometer /Minute Volume Exercise settings for exercise

It's fairly individual...

by crustyg - 2022-02-20 12:51:36

But I'm happy to share all of my settings.  Initially carefully tuned for road-cycling and got it right first time (5 separate spins on a static bike in one long session).  We (BostonSci rep & I) made some mistakes during the session, but happily hit on the optimum MV settings after an hour.

Accelerometer wasn't so good for static high-effort work, e.g. Pilates/Yoga poses and it's far from perfect for lane-swimming, not enough feed into RR but I'm not sure that I can see how that can be improved with accelerometer + MV feeds into RR.  By far the biggest pain with MV is the slow initial response and the damping effect of blended sensor input while MV's signal is 'slower' than accelerometer.  But once this is past MV whizzes my HR up as it should.

I have two specific reasons for not wanting to over-drive HR, but looking at last Dec's in-person histogram PM reports my HR is still heavily skewed to the left which I'm happy about.

Send me a PM, please.

PM Brand Switch

by IAN MC - 2022-02-20 12:58:59

Hi Selwyn

Like you, I am in the UK and am due a PM change in the next few months .  I am keen to switch from Medtronic to Boston Scientific for the same reasons as yourself  i.e. for the improved Rate Response features.

So far I am failing to persuade my cardiologist to do the switch as, in his words , " there is no published data on mixing box and different -brand leads " ...... he is quite a conservative man !

Did you have to do a big persuasion job and do you have any advice ?

Thanks

Ian

" there is no published data on mixing box and different -brand leads "

by AgentX86 - 2022-02-20 16:53:03

If you're talking about MRIs, that's exactly the problem and why it's not likely to be fixed. Pacemakers are "conditionally MRI safe". One of the conditions is that the leads and box match.  I don't know how it is in the UK but here, drugs and medical devices can be used "off label" but it's the physician's ass if anything goes wrong.

Yes, they're conservative when their malpractice insurance and their license is on the line.  That's not to say that it's impossible to find someone who will do an MRI with a mixed setup  but it's a lot harder to find someone who will, other than in an emergency where the patient is likely to die without on.

I don't thing the settings for one person will be much of a help for another. People are just too different. MV doesn't even work for many.

Boston Scientific Accelerometer /Minute Volume Exercise settings for exercise

by Selwyn - 2022-02-21 12:22:30

Thanks for your ideas. I will PM you crustyg.

Ian, I had a telephone consultation with my consultant electrophysiology, cardiologist at Liverpool Heart and Chest. I asked him, "Is there a choice?". He replied, "Oh, I have never been asked that". I told him I was after a Boston Scientific, and behold, at my PM check the following week, I had been listed for a Boston Scientific!  I was told as long as the leads fit, then that is all that is required. Clearly, as time goes on, leads and boxes may not necessarily be of the same brand.  This is confirmed by what I have mentioned below...

With regard to mixing PM and leads, I did contribute to a post concerning MRIs, 

Mixed Leads - Contraindication for MRI

BY SHANA  2021-10-10 19:41:09 

I think your consultant is ill informed:

see https://thoracickey.com/choosing-the-device-generator-and-leads-matching-the-device-with-the-patient-2/

"The pacemaker lead or leads and pulse generator selected do not need to be from the same manufacturer. It is generally acceptable to "mix and match" leads from company X with a pulse generator from company Y, assuming similar functionality. What is mandatory is that the lead connector be compatible with the connector cavity of the pulse generator."

I think further consideration and negotiation should take place. You can always mention  you have heard that Liverpool Heart and Chest is doing xyz ! That, as it were, should shock him!!

Thanks very much Selwyn

by IAN MC - 2022-02-21 14:41:06

I do like your question " Is there a choice ? " and will certainly use it.

I know what the answer would have been 11 yrs ago when I had the PM fitted as I was told at the time that I was the first "active" PM patient he had seen !   Maybe 11 years on, he has seen more runners / cyclists etc.requiring PM's.

Fortunately my dissatisfaction with the Medtronic accelerometer is not huge; I just think that cycling may be easier with the Boston Scientific dual sensor.

So if I lose the persuasion battle, it won't be the end of the world.

I will also mention your Liverpool experience ... that should impress them .......... but I  do wonder who exactly would have done studies to confirm that a lead connnector is compatible with a different brand of PM  /leads  ??   It would not seem to be in the commercial interests of the PM manufacturer to do such studies ?

Thanks again

Ian

The leads have an international standard connector

by crustyg - 2022-02-22 09:13:26

There isn't an issue of leads from vendor <a> not being plug-compatible with a PM from vendor <b> - there's an international standard for that that everyone follows.

The (mostly theoretical) issue is whether the outer shielding of the leads makes an effective faraday cage to stop the lead acting as an aerial during the RF pulses and steering magnet changes during the MRI scan.

There does seem to be some history of the actual metal of the mating surfaces at the connectors causing a problem.  When BostonSci had a major over-sensing issue with MV in late 2017-early 2018, it was noted that this was much worse with non-BostonSci leads.  Given the tiny voltages involved in MV I can easily see how a small metal-to-metal junction of differing materials could produce a standing voltage which might affect the front-end amplifier used for MV.

Thanks Crusty

by IAN MC - 2022-02-22 10:22:23

I had figured that there must be international compatibility standards for pacemakers and you have confirmed it .

On reflection , it would be difficult for the PM marketeers to get any mileage from "Incompatibility" as a selling point !

Ian