BIOTRONIC PM

Three month check

by AgentX86 - 2020-07-17 12:39:14

Did you ask to see a PM tech for some tuning? This isn't automatic. Yes, they will check your PM, at times, to make sure everything is a working as it should. This isn't an automatic tuning event, nor is it the only time you can have settings changed. If you need changes made, make an appointment.

Biking is a hard one. Yes, an appointment with your PM technician is a good move but there is no reason that you have to go through your cardiologist to get one. He may need x to sign on on major settings change.

Static bike test - pros and cons?

by crustyg - 2020-07-17 13:48:05

Hi Moussa: I'm curious about what you've heard against a static bike test.

Arguably, my BostonSci Accolade isn't as clever as your Biotronic with CLS, so a formal tuning session was absolutely the right thing for me.  What I hadn't realised at the time, and even the BostonSci rep didn't seem to know, was that the MV feature is *very* sensitive to external magnetic fields, and many (perhaps most/all) constant-power static bikes have magnetic brakes which most definitely *DO* interfere with MV.  Even my carefully chosen fluid-braked turbo trainer at home generates a magnetic field which has *some* impact on MV - I've checked with the manufacturer and the impeller in the fluid chamber is steel, and has enough magnetism to generate a field which inteferes a little.   What happens is that the MV signal is *reduced* by the external mag-field, so the HR increase seen for any given workrate/ventilatory effort in the lab is smaller than out in the real world.  By happy chance (and I had a second session to check this), I can work *fairly* hard on a ride up the mountain without reaching maxHR - exactly as it should be - but then if I start to push, I reach maxHR and perform even better (joke there....).

My one gentle concern about CLS is this: if you spend enough time not doing a lot, does the CLS de-tune the rate response?  In other words, is the PM *always* learning?  Because if it *is* then this isn't ideal - you may have to work hard to teach it again what you need after a month doing not very much (or worse, it will over-pace you for a while).  This is very much against a Six-Sigma approach (gold standard for all high quality precision work) where, once the control parameters have been set, they should *never* be allowed to change except by deliberate active decision.  But I am *not* a Biotronic expert so my concern may not be valid.

As a *guess*, your EP team may feel that you don't need a tuning session if the CLS is working as designed.

Luckily for me, my condition is simple: SA-node failure=>CI=>PM pacing only RA, so all we needed was a PM tuning session and then I was sorted.  Others may not be so lucky.  I have one area of concern, having acquired a mild cardiomyopathy from my two long periods of AFlut, so over-pacing is something I want to avoid.  My pacing rate histograms suggest that we've got it about right.

Biotronik CLS

by IAN MC - 2020-07-17 14:10:03

Hi Moussa

As far as i know Biotronik is the only pacemaker which uses C'L.S . ( closed loop simulation )  for Rate Response. The fact that it simulates stress-related heart-rate changes as well as those required for exercise is interesting.

I strongly recommend that you enter C.L.S. into the search facility ( small magnifying glass, top RH corner ). There are loads of previous posts from cyclists regarding ( sadly) the limitations of the CLS system.

Biotronik settings can be tweaked until the optimum combination is found BUT .......the common criticism appears to be the inconsistent response when you cycle.

I see you are in Holland. It is pure speculation to make any assumptions about PM checks and tests. The Dutch system may be different to other countries in terms of frequency of tests, who does them etc

Ian