Not happy with new Biotronik CLS device.

I recently got a new Biotronik CRT defib pacemaker. This is my 5th device so I am very familliar with how they work and how to tune the settings. I specifically chose the biotronik because I was sick of the accelerometer only based systems. They either tend to overshoot or undershoot for a given situation. I was very excited to get this new CLS device but have been very dissapointed in the first week. 

I have all the rate response settings very conservative. Max tracking rate is 130. CLS and Accelerometer gain are both low. 

The issue is that this machine constantly over paces me for no rhyme or reason. I gently get in bed. 130BPM. I gently brush my teath. 130 BPM. Im just standing static after walking. It ramps me up to 130bpm. Its very uncomfortable and has allready causes some afib episodes. Im worried there wont be a resolution to this as I allready have the sensor gains very conservative. I really wish there was more parameters to tune this system. Something is not right and I wont be able to tolerate this device if I can't find resolution. This sounds a lot like the "sticky CLS" that DESMODRONE posted. Any advice would help. 

5 Comments

Hope the attached link helps someone to answer this post

by Gemita - 2022-02-20 16:19:11

This is the link to which Clayhuff refers I believe for those who are able to help.  Please copy and paste into your browser to view:-

https://www.pacemakerclub.com/message/41499/sticky-cls-closed-loop-stimulation

Find a GOOD Biotronik Tech!

by arentas80 - 2022-02-21 00:22:59

Your story sounds very familiar. I used both (CLS & Accelerometer) at one point but decided to turn them off because I did not suffer from chronotopic incompetence. I forget why they turned it on in the first place but long story short I've heard repeatedly it's the techs who can really get our pacemakers dialed in. Next time you're at the EP's office see if you can get their reps number. Make contact and see if there is anyone who "specializes" with the Biotronik CLS setting. Just a thought.... Anyhow I truly know how you feel so my thoughts go out to you. I used to stand and walk to the bathroom, 140. Walk down the street, 140. Step into the shower 140. I absolutely hated it. I hope you get yours resolved ASAP! 

Yes find an experienced Biotronik technician

by Gemita - 2022-02-21 02:36:02

Clayhuff, I hope you have been able to find some helpful recent info here.  There is a lot in the archives too from Inga (golden_snitch) who has a great deal of experience with CLS and has written many excellent posts on this subject.  Not sure if she is still a regular contributor to the Club though.  Haven't seen her for a while?

Clearly, as arentas80 also confirms, you need to find a very experienced Biotronik technician (or seek a second EP opinion in another hospital) to help with this since some EPs and their technicians, according to what I am reading here, may not always be able to help you.  I would do this before you consider changing your device.  I believe there are "expert settings" that are password protected and these can only be changed by an experienced Biotronik technician who will have access to these settings.

I am mindful that you have a defibrillator.  Clearly there is some urgency that the CLS problem is fixed quickly so that you do not risk having any unnecessary shocks should your AFib be triggered and cause a rapid ventricular response rate.  I hope you find a solution to this quickly

I both hated and loved my Biotronik tech

by Persephone - 2022-02-21 18:04:53

I didn't like the way the tech dialed me down all the way without warning while I was perched on an exam table - very irresponsible on their part.  I loved the way the tech made settings work for me... I don't know exactly what they were, but the world changed for the better for me that day.  Keep at it Clayhuff - keep being the "squeaky wheel" until you get your change.  May the wind be at your back.

Dialed it down

by AgentX86 - 2022-02-21 21:36:07

This is a normal test to see if there is an escape rhythm.  If you get to the bottom, you fail. They should say something like "this may feel wierd" beforehand.  Sitting on the exam table isn't good either.  The PM clinics I've been to don't even have exam tables, rather a chair similar to that used for taking blood samples (wide arms used to support the arm while the vampire mines for a vein).

Anyway, I'm one who fails the test too.  I call it the "elevator test". It's great that your tech got you dialed in so well, so quickly. I agree about being the squeaky wheel.  Squeak but do it nicely for best effect.  ;-)

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So, my advice is to go about your daily routine and forget that you have a pacemaker implanted in your body.