Cls settings - lower rate limit

Hi can anyone with experience with biotronik cls explain how their lower rate limit was decided on?

My medical team are not experienced with CLS, they do not usually activate it, and I am always the most knowledgeable person in the room at my clinic visits, which is very disconcerting.

I am due to have another trial of CLS after initially begging for it to be disabled after one night on my first attempt due to being pounded with a ridiculously high heart rate all night in bed.

After much research I have decided what to ask for on most of my settings but am unsure how to select a lower rate.

During the day, CLS was amazing and I did not just drag along at the lower rate at rest like I do with basic settings. It was 55 last time, they were going to give me 50 but I feel awful if I am still up when I drop to my night rate of 50 on the basic mode, and I feared being at 50 in the daytime.

I do not know what to request for my lower rate this time. I want to be as comfortable as possible and mimic normal physiology as far as possible too.

I am 42, female, small build and regular exercising if that helps.

Any information much appreciated - deciding on one's own heart rate is a challenging thing to do!



My take is that Lower rate is not really part of CLS...

by crustyg - 2022-07-22 11:31:52 the sense that CLS is all about raising and lowering your HR from the base level - the lower rate limit - that you have.

And lower rate is mostly controlled by your resting requirements and what you're used to.

An athletic type with SSS+CI whose natural resting rate at PM implantation is 40BPM isn't going to want (or benefit from) a sudden increase to a minimum HR of 60BPM: a) risk of causing hypertension, b) risk of overpacing and making sleep difficult.  A number of contributors here have PMs that automatically lower the lower rate limit at night to help them get to sleep.

So, for you, 50BPM during the day when you're moving about isn't pleasant, and 55BPM seems reasonable.  But what you really need is confidence that a) CLS *will* increase your HR when you need it and b) that it won't accelerate your HR straight up to maxHR on a single flight of stairs.  This is the tuning that I go on about - and you probably need a couple of calm, well thought out tuning sessions.  For me it was a static bike, for you it might be a treadmill, for someone else it might be dancing down the corridor (no, I'm being serious).

Maximum charm: try to sell this to your PM team as you doing *them* a favour, allowing them to learn and gain experience on a willing patient!  After it's gone well, they will know a *lot* more about CLS tuning.  It's all about having a feel for how sensitive the settings are: 'if we turn <Response Factor x> up by two levels, what does that do to the HR on movement?'  A 20BPM increase, or a 100% HR increase?  You look at kids learning to drive - sawing on the steering wheel, realising how sensitive the controls are.  Same with aircraft - even the big ones, small inputs may have large effects.  But other controls have less effect.  That's Experience.

Best of luck.


by AgentX86 - 2022-07-22 11:39:08

You may also ask for the Biotronic rep to help them learn more about CLS, with you as the guinea pig. It's not unusual for the factory reps to be around helping out with tough cases.  The device techs don't know all of the settings details of every model.  The factory reps do. That's their job.

Insist on a Biotronik rep being present

by Persephone - 2022-07-22 18:28:00

Require a rep to be there for your next round of adjustments - if your medical practice is implanting this brand of device, you can't be the only patient asking for assistance. I went through that "oh, you've got symptoms I've never seen before" kind of scenario with my clinic techs, but now the clinic regularly brings in the Biotronik rep for tune-ups - so maybe I don't have to continue to be that "most knowledgeable person in the room". Best wishes to you and hopes for continued improvement :)

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