Accolade Accelerometer and Minute Ventilation Settings

I just had a Boston Scientific (BS) Accolade L331 implanted. I am a biker and the Pacemaker (PM) has been of no help so far on my bike trainer-a Wahoo Kickr hooked to Zwift. I am going in to the EP in early January to get the PM adjusted. I am 83 and have been biking since I was 71 on a Roubaix. What settings should I ask the Techs at the EP lab to adjust and what would good numbers be. I have App A the programmable options from the BS set up book. So, I would be looking at MV Response factor, MV Fitness level, Age, Ventilatory Threshold, Ventilatory Threshold Response, for starters. They will put me on a bicycle stress test device when they have adjusted the PM. Additional adjustments as needed. Probably take a couple of sessions to get it homed in.

There is a Boston Scientific document titled Accolade Settings Manual which can be found at

https://www.bostonscientific.com/content/dam/Manuals/us/current-rev-en/359239-002_multi_RG_en-US_S.pdf

Appendix A of this manual, titled “Programmable Options” contains all the programmable options for the Accolade, their names, values, and initial or nominal values. Page A-1 contains the Accelerometer values, and page A-2 contains the Minute Ventilation values.

If anyone has had their Accolade set up and knows the Accelerometer and Minute Ventilation values that they are using, I would appreciate that information prior to my meeting with my EP and the BS technicians.


8 Comments

More questions

by Ahilltopper - 2022-12-26 20:05:49

In your bio you mention a recent diagnosis of chronotropic incompetence, which led to your recent PM implantation. I'd suggest, if you haven't already, ask your EP - what is the general success rate of a PM in treating CI in patients over 75 years, and in what time frame should you expect to see improvement in your ability to cycle without adverse symptoms? I did a quick check on Pubmed and found that CI is prevalent in the pacemaker population. In other words a PM implant doesn't appear to be a universal cure for CI, which is a multi-factorial progressive condition. That said, it is reasonable to want to optimize the PM for your diagnoses and activity goals. I wish you the best, and encourage you to ask questions and listen carefully. Your EP should be your best source of information, knowing your heart as they do.

chronotropic incompetance for bikers

by rmarkley - 2022-12-26 21:12:42

Hello Ahilltoper,

My BS Accolade L331 has both an accelerometer, which will help runners, but not do much for bikers, and the new RightRate Minute Ventilation sensor which is supposed to increase your heart rate as a function of breathing.

We will see if that approach works when I meet with my EP and his technical folks, including someone from BS on Jan. 13. The plan is to make the appropriate adjustments and then put me on a bicycle stress test device. Any follow up tweaks can then be made.

CI and pacemaker

by AgentX86 - 2022-12-26 22:15:33

I think what Ahilltoper is saying (correct me if I'm puting words in your mouth) is that rate response isn't perfect. It works great for some, not as well for others.  There is no one-size fits all. Don't expect perfection. You probably won't get it.  Your EP can work to dial it in but there is no guarantee (read: unlikely) that it can be set up to handle all conditions.  The SI node has really good information to work from.  Pacemakers can only guess.

CI setup

by rmarkley - 2022-12-26 23:55:11

hello AgentX86

Is this the voice of experience talking. The accelerometer works poorly for biking, and it sounds like RateResponse should work. The challenge, I guess, will be setting it up. Probably take several tries.

Experience

by AgentX86 - 2022-12-27 15:25:55

Not personal, no.  I don't bike or swim but there are plenty here who do and the subject is a very common one.

I do, however, have experience with  poor rate response for higher than normal exertion. Once in a while, I'll do something that requires a lot of energy, like moving furniture, or some such.  The feet may be moving but not nearly enough.  A normal SI node would sense the additional CO2 in the blood and increase the heart rate to compensate.  A pacemaker can't do that.  A accelerometer based PM will see some foot-falls but will assume you're just walking.  I have (too much) experience here.  The second flight of stairs or moosing a hand truck around can be a problem.

Minute ventilation should better but can be very hard to set up.  Some here have had to have it shut off.

 

Triathlete

by stevebne - 2022-12-27 19:38:32

Hi Maxwell Smart!

I am a triathlete and seem to have overcome most of the challenges with the settings across the three sports. Unfortunately, the standard PM settings are at best designed for running as the constant jerky motion in 3d seems best at triggering the accelerometer, Cycling, especially indoor cycling has very little motion and even that is mostly at a steady rate and hence not noticed by the accelerometer. That leaves you with minute ventilation but even here, the usual settings mean nothing much happens until you are breathing very heavily and fast. (Note that it is MV and not respiritory rate hence breathing fast and shallow doesn't work!)

I do most of my bike training indoors (Fulgaz, but essentially the same as Zwift and the others). I can get my heart rate up using fairly aggressive settings. Happy to share these with you on a PM if you wish. Another interesting option is to have a bike session at the cardiologist with the tech present so you can adjust the settings and see the outcome in real time. Note that your heart disease creates its own limitations as a higher HR may result in bad events such as heart block etc and hence your response may be purposively limited. 

 

Maxwell Smart!

by AgentX86 - 2022-12-27 23:15:31

That's only the second half of the joke.

I'm familliar with the operation of the pacemakers and also the limitations.  Optimize for one thing and others suffer - Whack-a-Mole. I've had mine (accelerometer) cranked up to the max (fastest, most sensitive response possible) and it's still not enough for me.  I'm quite sure it's not even close to enough for cycling.

Some can get them sensitive enough, then have their heart rate spike while they're driving down a bumpy road.  Watch what you ask for. 😉

"Bad events such as heart block".  Well, I have the mother of all heart blocks (AV ablation and no escape). Mine is limited but the rate isn't my limitation. It just can't sense my needs.

whacking moles

by rmarkley - 2022-12-27 23:49:31

I plan on using the Minute Ventilation feature for biking. We will see if that works.

You know you're wired when...

You have rhythm.

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