Dual-sensor VS Biotronik CLS for biking, etc.

I will be replacing my current pacemaker soon, and thinking about what to replace it with.

My heart is too slow and won't speed up: bradycardia and chronotropic incompetence. (And there's a 2-1 AV Node Block at 115 bpm.)

I'm 60 and active. I mainly bike. But biking has been frustrating because my heart rate stays low because my pacemaker doesn't help. That's because my current Medtronic pacemaker has only a single-sensor, an accelerometer. I also run, and my pacemaker works for that, but my knees can't take very much of that.

Now it is time to replace my pacemaker. What do you think would be a better choice for my situation: a dual-sensor (minute ventilation + accelerometer) pacemaker? Or a Biotronik CLS? It sounds like both of them are capable of adapting heart rate while biking.

Thanks,
Mark


13 Comments

Sensor choice

by golden_snitch - 2016-02-28 08:02:21

I think the dual-sensor with motion + minute ventilation sensor might fit your needs better than CLS. I find CLS a bit slow to adapt to cycling, even though the response is set quite "aggressively". It does respond much better than a motion sensor only, but to cycling it really responds much slower than to running, for instance. I often get short of breath when I ride my bike and I need to go a little bit up a hill. As far as I remember riding my bike when I had the dual-sensor, the response I got was better than it is now with CLS.

Best wishes!

Other dual-sensor cyclists?

by AbNormative - 2016-03-15 08:03:51

Are there other chronotropic incompetence folks out there who can confirm that dual sensor pacers work pretty well for cycling?

Short Summary about Cycling

by AbNormative - 2016-04-02 07:04:22

I assume your diagnosis (like mine) includes chronotropic incompetence: heart won't speed up appropriately during exercise.

The short summary is (and others please correct me if this is wrong):
- Medtronics and St Jude pacemakers will NOT increase your heart rate for cycling.
- Biotronik pacemakers will increase your heart rate for cycling, except they are flaky/inconsistent.
- Boston Scientific and Sorin pacemakers (dual-sensor pacemakers) will increase your heart rate for cycling.

Biotronik a bust for cycling

by Eddiethedog - 2016-04-02 12:04:52

I am 69 and an avid cyclist. Over the past few years I'd experienced increasing shortness and leg muscle pain. Diagnosis:bradycardia, sick sinus. Prior to implant in Sept 2015 resting rate was 45-55, and under heavy exertion in the 90s. Doc recommended Biotronik CLS. It seemed fine until I was recovered from the implant and returned to cycling. Short story: inconsistent, unpredictable results. In six months, I had an appropriate rate in the 120s while spinning fast just once...and after a half-hour break could not generate a hr over 80. That was November. After multiple resets and a dozen trips to the clinc, we are looking at other devices. And I must add that the Biotronik techs have tried but ultimately are sure their device is not the problem. My ep disagrees. Next week I'll be exploring devices from Boston, Medtronik and St. Jude. Any experience with those and cycling?

Chronotropic incompetence it is

by Eddiethedog - 2016-04-03 05:04:38

Thanks, AbNormative. Yes my diagnosis is cp. Your description of "flaky" describes mt CLS experience. It was getting so unpredictable that the cardio ep turned off CLS and for two months it was just accelerometer--and every bump or jiggle on the road, or just flopping into a chair, caused a 20-30 bpm spike. Make me nauseated. My doctor has suggested Boston Sci as a good option to enable vigorous bicycling. What has been you experience with Boston?

Cycling and accelerometer

by Wardie - 2016-04-10 06:04:03

I am also an avid cyclist and just had a pm inserted last December. I have a Medtronics pm and it is now set to rate response. Not sure if this is just an accelerometer and, once the snow melts and I can ride again, whether on a bike the accelerometer will pick up that I am exercising. Am I right in saying PMOs have two sensors: 1. Activity (the accelerometer, I presume) and 2. Minute ventilation (which I think measures respiration rate)? My sense is, as cyclists we would need a pm with option for both but I'm a total neophyte so not sure at all about this and just worried I won't be able to keep up with my buddies on the long (particularly when hitting the hills).

Ask your cardiologist

by Eddiethedog - 2016-04-12 03:04:30

I don't know what your pm has, but just today my device clinic tech told me that if the Biotronik CLS isn't working for me, as a cyclist (see above), then the best choice would Boston Scientific Accolade modl 301. It's combination accelerometer and minute ventilation. He said neither Medtronic nor. St. Jude have a blended sensor (two wire) device. I'm interested in what you learn from your own shop.

Many thanks!

by Wardie - 2016-04-14 12:04:52

Many thanks for that. I'll have to raise that with my ep. My pm is a Medtronic A3DR01. Will give the bike a try soon. (No more snow in the forecast!) Part of my problem is the fact that as I approach max bpm, my heart drops 30-40bpm. Not great in the hills, for sure. The rate response is supposed to indicate to the pm that I'm exercising so that does not happen but I'm worried now that I don't have the right pm. (As I have to have an MRI every two years for another issue, the pm that I have is one that will allow me to do that. I'm just afraid that I might not be able to get everything I need in one pm. Probably asking too much.)

Traded in Biotronik for Boston Sci

by Eddiethedog - 2016-06-03 03:32:38

After eight months of wildly inconsistent results from the Biotronik CLS, with more than a dozen adjustments, my EP just two days ago implanted a Boston Scientific Model L311, which is a dual lead (accelerometer plus minute ventilation). As you can read above, the cardiology tech recommended this type. I'll get on my bicycle in four days and let you know how it goes when I hit the hills, with the understanding that fine-tuning will undoubtedly be needed. As Wardie says above, it would be asking too much to have "original equipment" again. But I'm grateful to have 1) A life, 2) An active life. 

Update on cycling with Boston Sci

by Eddiethedog - 2016-06-29 02:22:01

Have had the Boston Sci minute ventilation/accelerometer model LC-311 for four weeks and several bicyclke rides of 25-30 miles each with many hills, most of them short and steep. I am so happy to have moved on from the Biotronik, which was very unpredictable in its response and, more often than not, failed to respond at all. Not only that, but I was having a-flutter and other arrhythmias that had never occurred before.The Boston Sci works predictably, and on my two-week interrogation was found to have had no flutters or arrhythmias at all. I've found that, so far, the Boston Sci needs some time to respond to my needs--halfway up a 100-yard 6% hill, there's barely any rise in hr. about when I get to the top, the rate comes up from around 100 to the 120s. It had taken a quarter-mile hill to get the hr up to the max of 140. When I'm feeling just about ready to peter out, the device kicks in and I feel better at the top than midway. So...if this is the best that can be, I'll gladly accept it. Hope this is useful to some of you.

2023 updates for good pacemakers for cycling?

by dlbdata - 2023-01-11 03:35:08

This is a great thread. I've had a Biotronik for a little over a year. I suffer from Bradycardia and chronotropic incompetence (CI). Initially the Biotronik was set to use CLS, but like others here, I found it's function very erratic and unpredictable. I saw a different EP, and he disabled the CLS on the Biotronik. Overall that seems like it was a good choice, my rhythm feels more natural, but now I do feel like my CI is holding me back some. I'm not sure what sensors it is using if CLS is disabled, I probably need to follow-up with the new pacemaker specialist at the new EP.'s office, and see if there are any "tweaks" they can make.

But my question is now that almost 7 years have gone by since this thread started, are there now better pacemaker options available for cyclists in 2023?

old thread, perhaps do a new post for better responses with link to this one?

by Gemita - 2023-01-11 04:05:02

hello dlbdata,

Just caught your comment while going through some housekeeping.  Might be good if you copied this message into a new post on the message board so that more will see it and hopefully respond.

Some members are very knowledge of pacemaker settings and may be able to private message you and give you some ideas to discuss with your technicians to find the best settings for you to help.   I have a Medtronic so cannot offer any assistance and I am not a cyclist although I do have to struggle with initial exercise exertion and am finding rate response setting a bit of a nightmare.   It is a long journey to optimising our pacemakers to suit, but it is well worthwhile the struggle in the end.

Good luck and hope you are doing well

New posting instead

by dlbdata - 2023-01-11 06:56:08

Thanks Gemita, wasn't sure which would work best.  I'll try that instead. I wish there was a way to get notified of comments on my posts. Also I have the email notification selected, but it never notifies me.

You know you're wired when...

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At age 20, I will be getting a pacemaker in few weeks along with an SA node ablation. This opportunity may change a five year prognosis into a normal life span! I look forward to being a little old lady with a wicked cane!