Experiences with Boston Scientific PM

My experience

by crustyg - 2019-09-19 09:42:35

I had an Accolade EL implanted in May this year: I'm a keen cyclist, swimmer and ex-competitive runner who now does Bodybalance, Pilates and Yoga.

I got my EP doc to arrange a static-bike tuning session to get the Minute Ventilation set up sensibly for me about four weeks post implant.  I have SSS+brady+chronotropic incompetence.  I'm 100% paced, but not PM dependent as my junctional system can get me up to about 110bpm, resting HR about 35-38 without the PM.  I'm set to AAIR with 50-160bpm.

It's been a great success: I cycled a 56mile sportive last Sat, kept up with some good riders most of the time, I was cycling up Mt Tiede in Tenerife last month and could keep up with my chums some of whom are good and young.  My cycling muscles find my heart output at max HR plenty, so I can keep pushing without legs turning to jelly. I do a little bit of hiking in TFE, no problem at all.  The accelerometer does a good job for running - I'm close to what I could achieve before my rhythm became an issue - but I only run once a week.  Swimming is a challenge, as there's not enough drive from either sensor to drive my HR - accel is still at original response factor setting, but this coud be increased a lot. Stairs - easy, two at a time.  Before PM I would have to go one at a time, and stop at the top and hang onto to something to avoid falling over.

Hope that helps.

Thanks Mike for your post …….

by IAN MC - 2019-09-19 12:30:03

Like you, I currently have a Medtronic  PM and am hoping to switch to a BS Accolade some time  in the next 6 to 12 months, the reason being that the accelerometer sensor in the Medtronic is totally inadequate for cycling.  I was a keen cyclist and marathon runner but because of Medtronic's Rate Response limitations now rely on short runs, tennis, gym workouts, and walking around a golf course to keep fit !

Have you confirmed that your EP is willing to do the switch ?  Mine is a very conservative guy and is worried that the MRI-compatible leads on the Medtronic may not match happily with the Accolade box.  I am using all my powers of persuasion to get the PM that I believe will be best for me.

Crusty :   Your positive feeedback was music to my ears. I was pleased to read that having  setting -adjustments while on a stationary bike worked so well.  Did you consider also having further adjustments while you run on a treadmill; this should help optimise the accelerometer settings ??    I can't think of a way to get perfect settings while you swim during the adjustments though  :- )

Ian

Useful comments

by Mike417 - 2019-09-19 18:29:31

Crustyg and Ian,

Thank you both for your comments.  Ian, My EP doc clearly stated he would replace it. I have an appt. Monday to discuss timing. He chose the PM, saying they were similar and the hospital put in a lot of M'tronics, and when I look in the waiting room no one looks like me - an active 66 yr old man. I am worried whether insurance will pick it up. He will have to put in new leads - he was unable to get the ventricular lead in because a rib was in the way, so he will have to reposition and put in new leads.

Crustyg  Boy, that sounds terrific.  Just what I was hoping to hear. I am very encouraged and want to move forward!

Anyone else comment?

Mike

Further tuning?

by crustyg - 2019-09-20 04:38:22

Hi Guys:

Thanks for the kind words.  The default sensor setting on the accelerometer (8 - 1-16) is fine for me, I rapidly hit my max HR when running even at 8.  I have a very mild cardiomyopathy, presumed from my second 6 months in flutter (fault on both sides of the table), so I don't want to push my HR any more than I need to, so although I *could* ask for accel response to be increased to help with swimming, it's not worth it in my opinion - for me.  No sign of coronary disease, seem to be able to cope with 3-4hr cycle with max HR for about 90% of the time - legs love it especially the climbing.

Static bike: they *must* use Zip telemetry to monitor your HR - the small print in the manual explains that wanded telemetry messes up MV sensor for up to 2min after each usage.  We did my first bike session using my Garmin chest strap and Edge 520!  Took about an hour, must have done about 5 goes, with a very careful 10min warm-up before I started pushing.  About 4 re-programs to tweak things.  Interestingly on my road bike (tyres at 110-115psi) the accel does quite a lot of the HR increase to about 120bpm, and then the MV takes over.   Get the Patient Activity level set to Athletic - locks the long term MV baseline at 90bpm).  Strongly recommend you get and read the Brady Ref manual from BostonSci - easily obtainable.

Second session - we didn't change anything but it did prove that the accel is very active on our poor road surfaces!

Happy to message if it would help you.

Leads to PM: all follow an international standard, so they mate correctly and lock.  Yes, some MRI facilities will refuse you if the original box+leads have been changed, even if it's all stated to be MRI-safe.  CYA.  BostonSci say they have fixed the noisy MV signal issue with third party leads with a software update.

Best of luck!

I’m happy.

by PacedNRunning - 2019-10-01 03:20:35

I have the Boston Sci Accolade pacer and I'm happy with it. I run, bike and golf. I don't use the MV or accelerometer or rate response. I have heart block so I pace 100% in the bottom lead during exercise but the Boston Rate Smoothing saved me or else I wouldn't be able to run/exercise. All those bells and whistles are there if I ever need them. My doc picked them out bc he knew I was active. Just double check your leads are compatible for the MV sensor. I know there was an issue a couple of years ago