OPTIMIZING MEDTRONIC SETTINGS FOR EXCERCISE

I have had an ADVISA installed since November, 2015. During the first few months several adjustments to settings eventually arrived at fairly ideal pacemaker responsiveness, yielding a steady 140 to 148 bpm during jogging, (at about 10 minute per mile pace). However, I have not been able to achieve the same responsiveness during bicycling nor mountain climbing. I assume it is because my body movements do not generate as much accelerative force compared to jogging. So my questions are:    1) Has anyone tried lowering the "Activity Threshold" setting from Med Low to Low to achieve a greater response to excercising that produces less body movement than jogging? I am concerned that changing this setting will make the pacemaker overly reactive to my jogging.    2) I know one of our regular posters has had success by turning "Rate Response Optimization" to Off. The ADL and UR set points are then set manually. (My set points are now at 44 and 146, which are set by the Optimization algorithm. Our regular poster has his set points at 20 and 70, and that has worked well for his workouts.) Has anyone else tried this approach and with what results? If it helps to know, my Lower Rate is set at 50 bpm, ADL rate is set at 115, and Upper Rate is set at 160. Also, my Rate Adaptive AV is turned On, starting at 110 bpm, (once this was set, a problem I had with blocking was corrected). At this time my pacemaker is pacing only a small percentage of the time, I think mostly during sleep and when jogging. I would greatly appreciate any suggestions. Thank You, Frank

6 Comments

It will work better

by PacerRep - 2018-03-03 23:48:56

The only way to really know is have the change done and take it for a test drive. Medtronic sensors aren't really known for their programmability and things like biking and more stationary exercise is always going to confuse the device. Everything you've metentioned seems like competent changes to me, see if it works better for you. So again, I say give it a whirl, and if you hate it, go back in and make him set it back, you don't have to wait for your next appointment to have it switched back.

Thanks

by frankmcw - 2018-03-04 00:03:54

As I was writing my posting last night, I had sort of arrived at your conclusion. I am going to first try turning off the Rate Response Optimization (as mentioned in my second question). I know this is a common issue for bicycle riders with Medtronic PM’s. I will post again after the adjustments are done, in case anyone is interested. Thanks for your input.

I dont' think that will affect much change

by PacerRep - 2018-03-04 00:24:02

Just turning off the RRO probably won't get you what you're looking for, feel free to try it. My frist crack at it would be changing your threshold to a more aggressive setting as you suggested, it might get your rate response up more during those activities.

When a device has just an accelerometer like yours does, there just isn't a whole heck of a lot you can do except tune the threshold and the gain on it.

Good luck

Thanks Again

by frankmcw - 2018-03-04 01:27:36

Hmmmmmm, this gives me more food for thought. I had originally thought increasing the sensitivity (by turning the Activity Threshold to Low) would be the logical way to go, but I have heard from another poster who had success by turning off RRO and locking the ADL & UR setpoints to 20 & 70 respectively. The theory is that for a person that excercises a lot the RRO algorithm is continually raising the setpoint values, thereby impeding the increase of the higher atrial pacing needed for vigorous exercise. It sounds like I will need to experiment a bit. Thank you.

I have the same problem

by IAN MC - 2018-03-04 07:52:19

I too have a Medtronic Advisa  and suffer from chronotropic Incompetence so like you I need Rate Response.  I also am keen on runnning and cycling.

In the past 7 years, I have tried every Activity Threshold setting..... Low, Medium Low, Medium High, and High.,

I have had Rate Response Optimisation switched off, I have had it switched on . At the moment  I  have it switched back on . I think It is better on for me but we are all different.

I have had countless adjustments done while I run on a treadmill . My people at the local hospital are very competent when it comes to adjustments but ,  on one occasion, I persuaded them to bring in an expert from Medtronic's head office  .  He stated that " Medtronic pacemakers are NOT very good for cyclists who need Rate Response" and virtually admitted  to me that I would have done better with a different make !!

I believe that PacerRep was making a similar point.

You need to decide which activity is most important to you, cycling or running,  because I don't believe that any combination of settings will enable you to do both to a satisfactory level.. The Medtronic sensor has its limitations particularly for cycling where there is not enough vibration or upper body movement

With the accelerometer sensor the settings are something of a trade-off. If you try the Low activity threshold setting the most minimal type of exertion will increase your heart rate so you end up with an improvement in your cycling but the trade-off is that your heart rate will surge if you sneeze or walk up a couple of steps. At the other end of the scale on the High setting you will only get a response to vigorous movements and exertion which may be good for running but not for the normal activities of daily living.

I have found that another complicating factor is that chronotropic incompetence can be an intermittent condition,  The sinus node is more lazy some days than others

Regrettably I don't believe that any make of pacemaker has Rate Response sensors which are totally physiological . Nothing is as good as a normally functioning sinus node in my view.Having said that, PMs with more sophisticated RR sensors may offer an improvement over the Medtronic. Sorry to end on such a gloomy note but it is just a case of deciding priorities and changing one's athletic expectations

Best of luck

Ian

Thanks for sharing!

by frankmcw - 2018-03-06 00:17:26

I really appreciate your sharing your experiences with Medtronic PM settings. I believe I now have a clearer understanding of what to expect from the available adjustments on my device. I will post here again once I am able to experiment with the new settings. Frank

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