Biotronik Enitra 8 DR-T

I'm researching a couple of pacemakers and wondered if anyone knew anything about their pros and cons for a) rate response b) management of v.pacing c) mode switch options and any other algorithms which are effective / ineffective / useful : Biotronik Entera 8 DR-T & Medtronic Azure S DR

Many thanks in advance


Biotronik vs Medtronic ???

by Gemita - 2023-01-19 16:22:26

Penguin, please see the first Pacemaker Club thread below.  It is an old thread but worth reading. Clearly Medtronic is the largest manufacturer out there, so most NHS clinics/hospitals (and indeed most hospitals around the world) should be familiar with their products and you shouldn't have any problems with any future checks/adjustments should you ever seek help away from your own clinic.

Several members have found the Biotronik closed loop stimulation (CLS) rate response sensor setting difficult to manage. Really your EP should be advising you based on your lifestyle requirements?  This is perhaps the most important question you need to ask yourself?  How well will each pacemaker perform when I carry out my usual daily activities/which is the best pacemaker for my lifestyle and heart condition?  This is equally as important as ease of managing settings like the CLS, mode switch options and other algorithms which might be effective/ineffective/useful.  Hopefully members with Biotronik pacemakers will see your post and comment.

As a Medtronic pacemaker member, I am very happy with my pacemaker and the support I have so far received from my clinic and from Medtronic, but I am not a particularly active person, so I haven't exactly fully tested the device!

I attach links on Biotronik Enitra and Medtronic Azure.  I cannot find reference to Biotronik Entera only reference to Biotronik Enitra.  The Biotronic Enitra seems very compact and light.


by new to pace.... - 2023-01-19 16:31:39

I have the Medtronic  Azure MRI Surescan  have not had any problems with this model.  This is my first so have nothing to compare to.  Am sure when am due for a replacment in just less then 10 years will have some up grades.  Which should be my last one, am now 82.

new to pace

Thanks for Links

by Penguin - 2023-01-19 16:40:39

Hi Gemita, 

Many thanks for these useful links and your comments re: your Medtronic device. I have noted that some 'very fit' members of the forum find RR to be an issue. Although I'm no sportswoman I need enough energy for sightseeing when in hot climates and being able to access all that I want to see and do on holiday, swimming (leisure) and walking.

...and yes it's Enitra - wrong spelling sorry! 

Many thanks 


Medtronic Rate Response

by Gemita - 2023-01-19 17:42:38

Hi  Penguin, yes you are correct Rate Response can take a while to get adjusted to suit but if your technicians are patient and you work with a Medtronic rep as well, if needed during treadmill testing, it is possible to find a setting to suit you and your lifestyle.

There is a member here who is very experienced getting his Medtronic settings tuned in for his particular activities and he has sent me a sample Settings sheet of some of his personal settings.  The member is frankmcw2 and if you search on his history it should bring up a lot of useful info Penguin.  He always speaks favourably about the possibilities of getting the Medtronic settings adjusted to suit most activities.  Although there may be better pacemakers out there for specific activities like cycling, this particular member is also a cyclist and he was still able to get his settings optimised for him personally and was not held back at all.  It all depends on the willingness of your technicians to support you too and your determination never to give up the search for a better QOL.

Hopefully in the next few months I will learn more about my Medtronic Ensura pacemaker, what it can and cannot do for me and give you more information as I learn too.  I did try having my RR settings switched on last July-October but I noticed an increase in episodes of tachycardia Penguin, but I had RR turned on during a difficult spell of rhythm disturbances, so I will never really know if RR made my symptoms worse.  RR has now temporarily been turned off until I return to clinic in February.

MRI Conditional pacemakers with old leads

by Gemita - 2023-01-19 18:39:08

Penguin, all new pacemaker models will be MRI conditional today I suspect.  Some members with old leads that are not safe in an MRI environment have still successfully had MRI's.  Not sure that I would be quite so brave although providing certain conditions are met and the MRI technicians have experience working with pacemaker patients, this seems to be quite common now.

Perhaps they would consider removing your old leads too although more invasive.

Leads & MRIs

by Penguin - 2023-01-19 18:50:31

 I had no idea that MRIs could be done with old leads. I'm obviously out of touch. 

If the old leads are replaced what happens these days?  Is it dangerous to take old leads out?

It was discussed some time ago, but opinions vary.

Old leads and MRIs

by Gemita - 2023-01-19 19:11:48

I know of several members who recently had MRIs with old leads, some clearly felt a bit of "heating" of their leads?  

It is invasive to extract a lead and will of course carry a greater risk than leaving the lead in place and feeding another lead beside it, but not necessarily dangerous if a lead is extracted by an experienced EP.  You would need to go to a centre of expertise to have this "safely" done.  You could ask your EP if he has carried out any extractions and his success rate?  

Of course, some members have one or more leads placed in the same vein, so decide not to extract.  Not sure that my veins could take another lead since I had partial blockage of one of my veins during my implant, although they do heal.

There are quite a few members who have successfully had their old leads removed but they went to the "experts".  I am not sure how they actually carry out the procedure or what extraction tools they use, but really delicate task to dislodge the lead tips attached to heart tissue after so many years I suspect without causing damage.

old leads

by Tracey_E - 2023-01-20 09:55:55

If leads are more than 10 years old, it will be very difficult to find a facility wlling to do an MRI. 

Lead extraction is low risk when done by a qualified surgeon. It used to be considered high risk but the number of experienced surgeons has increased substantially as more of us are paced for a lifetime, and the equipement they use have come a long way also. You want someone who does 100+ a year. It's done with a laser, millimeter by millimeter. 

I have an old capped off lead, there was room in the vein so they added the new one next to it. Because extraction surgery has come so far, that is no longer the preferred way to do it. But I've had that capped off one in there since 2010, still have one working lead from 1994. No issues whatsoever. 

Back to your original question, the biggest weakness with Medtronic is the rate response is motion activated. If you have av block or only do activity that moves the chest, it will work great. If you cycle or swim, and you need rate response to get your rate up, then Biotronik is a better choice. However, the Biontronik is only as good as the programming. If you don't have a doctor who is very familiar with it, you are likely to have issues. Biotronik are much less common than Medtronic and St Jude/Abbott. Whatever device you get, make sure it's one your doctor knows inside and out because without proper programming, you could have issues. 



by Penguin - 2023-01-20 11:47:57

Thanks Tracey-E,  with the Biotronik being a DDD pacer is it recommended more for people with AVB and do you know if it has any effective algorithms for limiting unnecessary VP? 

I realise that UVP isn't a concern for you, but I'm not keen on the idea.  

Everyone seems to be remarking on RR with Medtronic! 

Gemita, thank you for the information re: lead extraction (and Tracey-E) I'll store it away until I need it! 


unnecessary pacing

by Tracey_E - 2023-01-20 14:37:03

All of them have features to minimize unnecessary pacing. However, keep in mind if you have av block you are likely going to pace every beat. That's the definition of complete/3rd degree av block- the natural signal never gets through. 

AV Block - Tracey-E

by Penguin - 2023-01-20 16:54:42

Sorry - I keep using the wrong terminology re: AVB. 

I don't have complete block.  

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