best sensor, best implantation technic for multiple sport

Pacemaker choice

by AgentX86 - 2021-12-27 17:02:40

Hi Peace, welcome to the club that really wants no new members.

The reality is that it's highly doubtful that you'll have a say in the pacemaker.  The best you're likely do is make sure that your EP knows exactly what sports you're into and discuss them with him.  Let him know that you know the type of pacemaker matters. It still may not help for contractual reasons.

The implant location is optional. Sub pectoral is better for sports and looks, if you care about such.  Sub-Q is a whole lot easier and heals faster.  That should be up to you but some EPs aren't so happy doing sub-pec. Ask about all this stuff.

To answer your question, most pacemakers use an accelerometer to sense activity and attempt to correlate that to oxygen need.  This can be tuned reasonably well for normal living and usually sports where your torso, hence pacemaker, moves.  However, the chest doesn't move much in sports like cycling.

There is an additional sensor in Boston Sceintific PMs that also measures respiration.  This, in addition to the accelerometer can do a better job of estimating oxygen need. "Can" being the operative word.  It works well for some and not so much for others.

I'm not sure what "ease of 35-40/min" means but my guess is that your Bradycardia is normally 35-40bpm, when it gets to 42bpm you have Cannon waves, and above 110bpm you have a heart block? There has to be a reason for the Cannon waves. Perhaps your heart block is >40bpm, causing the Cannon waves but they go away at 110?

Bradycardia

by The Right Pace Make Peace - 2021-12-27 21:05:15

MANY THANKS for your detailed answer!

Yes, you're right: normale 35-40/min, Canon Waves between ~42–44, above ~110/min av dissociation with multiple SVES.

you know the difference between boston duple Sensor and Biotronik cls?

Duple Sensor

by AgentX86 - 2021-12-27 21:22:49

I have no idea what "duple sensor" is. 

All pacemakers with minute ventilation sensors also have accelerometer sensors.  Often the MV sensor (or CLS) isn't useful so the EP can disable it and still have RR.

Two sensing techniques needed

by crustyg - 2021-12-28 04:22:42

My answer to your original Q about which PM is that you (with SSS+CI) definitely need something more than just the accelerometer that they all come with these days.

The Minute Ventilation tech that BostonSci have, uses a tiny AC-current to measure the impedance of your chest, between the metal can of the PM and either of the pacing leads. It measures both respiratory rate *and* depth of each breath, multiplies them together and produces MV which feeds into rate response. The tech involved is complex and has a lot of challenges: in addition, it must be tuned for you and your preferred exercise (and this is different to the calibration that the PM does for MV).  For those for whom it works well it's very effective - great for road-cycling, not so great for swimming (not much increase in MV) and pretty much useless for yoga/Pilates where there are a lot of static poses which require large muscles to work hard.

The Biotronik CLS measures how hard each heart beat is - you must have noticed that sometimes you really feel a heartbeat, which is caused by the sympathetic nervous system affecting your heart, even if you can't increase your HR much on your own.  When you work big muscles, part of your body's response is to tell the heart to beat harder, as well as faster - CLS detects this increased heart contraction effort and feeds it into RR, so your HR increases.  My local EP-techs tell me that they hear good things about Biotronik, and, in theory, it would work well for yoga/Pilates, swimming *and* road cycling.  But where I live they don't implant Biotronik.  Medtronic and BostonSci only, IIRC.  Mostly it's about having enough vendor-specific programming machines and staff training, but often there's a solus agreement in place, which is usually Medtronic, as they are the giants of the industry.

Good luck.

Boston Scientific

by PacedNRunning - 2022-01-01 04:54:22

Boston Scientific has the best senor for CI on the market. BIOTRONIK can be difficult to program and I've only noticed more issues with those patients than any other device. Unless you have expert doctors and pacemaker techs available to you, I would avoid that one. 
 

I have Boston Scientific it's great for sports with the MV sensor. If you cycle it's the best for that sport. It will increase based on motion and breathing depth and frequency. You can have it off if you don't need it but the blended sensors works the best over one sensor

under the skin is best for active people NOT under the muscle. Avoid that if you can. Mine is super low on my chest away from my collarbone and placed well  I run, golf, bike, hike, ski, lift weights with no issues.  Under the muscle and sports will put stress on the leads and cause more fractures than under the skin. Make sure your doctor knows your scribe because how they enter the vein will matter also.  My EP prefers under the skin for many reasons  

make sure who ever implants it does a minimum of 100 pacemakers a year.  Skill set matters for a good placement and optimizing your PM.  I was cleared to run at 2 weeks post op and all others things at 4 weeks.  Best of luck  

to Boston Scientific by PACEDNRUNNING and sensing technic by crustyg

by The Right Pace Make Peace - 2022-02-08 20:26:15

Thank you for your interesting answers. Yes the same sorts of sports are mine. Swimming too, strength training and I want restart volleyball, kayaking and motorcycling.

I have read, that there is not a very good device with enouph rate responce for swimming.

That your EP prefer the under the skine method for sportsmen is different to the recommendation in my mind. Can you tell me the special reasons from your EP. I think the stress on the leads is a hard reason, if it is so. The recommendations pertain to the protektion of the pacemaker device it self, probably. 

Yes, there is no much experience with CLS from Biotronik. In the sensing techniques is not so much development and science, or?

Ever the rigth pace for you, are in the pink of health!