Ongoing CLS trouble

Hi all, 

It has been a while since I have written on the forum. In May of 2015 I had an hybrid ablation due to persistent afib. Unfortunately I have binodal disease so a pacemaker was fitted. I am paced 85 percent in the atria and about 25 percent in the ventricles due to variable AV delays. 

Since the operation my mitral valve has started to leak moderately and my tricuspid valve is leaking more than moderately, most likely due to the pacemaker lead running trough that valve in combination with the fact I have thicker than normal valve leaflets. 

I have a Biotronic Eluna 8 pacemaker and have had many pacemaker setting changes. I was on Verapamil and Flecainide for six week because it was thought that my arythmia's (sometimes a flutter, short runs of afib, retrograde conduction) might cause the pacemaker to drop to resting rate almost each time I'd excersise. The medication gave me severe tinnitus and was discontued.

I am, after a long time back in cardio rehab and I experience the same thing. I excercise on the starionary bike, my heart rate goes up and after a while it drops to resting rate and I am unable to get it up again. This happends without any arythmia which leads me to think it is the CLS system. 

I am frustrated beyond words. If I walk sometimes I am ok, sometimes I am out of breath, I cannot excercise and work on my fysical fitness with a heart rate at 70 bpm. 

My cardiologist points a the pacemaker technician and the pacemaker technician tells me to learn and live with it and redirects me to the cardiologist. The cardio rehab centre says they leave it up to the cardiologist and the pacemaker technician. 

Is there anybody out there that has expert knowledge on the CLS system and can help me? I live in The Netherlands. 

Hartje5

4 Comments

Stationary Bike

by Artist - 2017-09-30 16:25:40

Members who ride either stationary bikes or street bikes often report trouble with their PM not increasing their heart rate enough to accommodate their exercise level.  The rate responsive feature in a pacemaker must be able to detect an increase in motion and the more gentle movement in bike riding might not adequately activate the rate response.  You could see if the sensitivity of the rate response feature can be increased.  Some bike riders actually tap their PMS to try to stimulate  the rate response and increase their heat rate.  Hopefully some of the members that ride bikes will have some more suggestions for you.

No motion detection with CLS

by Hartje5 - 2017-09-30 17:29:11

I am afraid that won't work. CLS does not work as a motion detector. If I ride the stationary bike I get different heart rates each time. Even at the same level of excercise. 

CLS

by IAN MC - 2017-09-30 18:10:33

Hello Hartje5

If you go into the search facility  ( small magnifying glass top right hand corner ) and enter  "CLS" you will find many previous posts on the subject.

Most posts seem to be expressing frustration at the inconsistent unpredictable  responses from the Closed Loop Stimulation ( CLS ) sensor for both running and cycling.

It seems to me that, if you exercise seriously,  the best Rate Rsponse system is to have a dual sensor ( minute ventilation plus accelerometer ) as used in some Boston Scientific models..  

I know that Biotronic claim that CLS is far more physiological in its responses but most people who have it seem to experience problems when they exercise.  I have read that minute chemical changes in cardiac tissue can affect the impedance which is detected by the CLS sensor .This then triggers off unexpected jumps and falls in heart rate .

I hope that you can find someone who really knows how to optimise the CLS settings to make it work as well as possible for you but it does seem to me that , for most sporting people CLS is not the perfect sensor.

Best of luck

Ian

 

CLS response

by chanceflight - 2017-10-03 21:17:33

I know this may sound a bit silly, but I run into the same problem when I exercise with the CLS. Most of the time the rate does not keep up with the exertion and physical movements of exercise. With me the CLS seems to accelerate my rate when I'm faced with a "stressed situation", meaning if I'm working complex ideas or thoughts, or if I'm anxious about something, the CLS increase the rate. 

So I apply this to my exercise. if my rate doesn't go up, I think in my mind of a stressfull situation. Maybe something like, " Oh crap, I have to hurry this workout up, or I'l really be late for work!". If the CLS senses that, often times it will increase my rate. 

Personally, I cannot get a good answer from the PM techs as to whether or not there is a "motion response" program to the Eluna 8. 

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