Cycling while 100% Paced

I've had a dual chamber Medtronics PM since 2008. In 2010, I received a catheter ablation, which leaves me atrium 100% paced from 70-130bpm. I have normal in-heart electrical pathways between upper and lower chambers. My issue is cycling, which I took up about a year ago. Most of our riding is road bike on paved roads. Bottom line is I get very little rate increase as we ride. I rarely see the rate rise above 104 bpm. On hills as I climb, the PM will actually slow me to 90-94 bpm when I need to do just the opposite. Coming out of the saddle sometimes helps, but that's a huge energy waster. If we are on gravel, I fare a little better. But... on those hills, my legs frequently run out of gas and I'm watching everyone pull away as I slowly climb dropping off as much as 10mph. My PM's RR is turned on and according to the tech, it's working properly. My cardiologist seems to think that it is what it is and doesn't offer any suggestions. I'm due for a new implant next year and would like to explore some options. Any suggestions would really be appreciated. Thanks in advance.

11 Comments

talk to Inga

by Tracey_E - 2015-09-02 11:09:48

Your device is waiting to sense movement before it raises your rate. On the bike, your chest isn't moving, so that's why your rate isn't going up. Tapping it might be more effective than standing in the saddle.

There are more sophisticated devices out there, ones that sense breathing also, that would work better for you. Inga (golden_snitch) is more up on that technology than a lot of cardiologists. If she doesn't chime in, do a search of her past comments. This comes up quite often.

Rate response

by golden_snitch - 2015-09-03 05:09:20

Hi!

As Tracey already said, your rate response sensor is the problem. Medtronic pacemakers have an accelerometer (motion sensor) only and this one needs upper body movement to sense activity. It usually does not respond very well to cycling because there isn't enough upper body movement. So far, I have only got to know one cyclist who was ok with this sensor, but he was mountainbiking, so the roads were bumpy and he was moving his upper body.
Unfortunately, there is hardly anything you can do when a motion sensor doesn't respond to cycling. It's a technical thing, nothing that can be re-programmed.

If you get a new pacemaker next year, look into getting one with motion sensor + minute ventilation sensor. Boston Scientific and Sorin Group offer this. It's much better than the motion sensor alone and responds to activities like cycling and swimming. Then there's also CLS (closed-loop stimulation) by Biotronik. I have that one at the moment since I can no longer have the sensor combination metioned as the minute ventilation sensor is not working with my epicardial leads. I must admit that I find CLS very tricky and often unpredictable in its response. It responds fast when I run, but not so fast when I ride my bike. Overall, it's really good for all activities in daily life (better than the other sensors, I'd say), but I do have problems when exercising. If you ask me, I'd recommend the motion sensor + minute ventilation combination.

Best wishes!

Thanks!!

by greyfox - 2015-09-03 09:09:32

To TraceyE and golden_snitch, thank you for your input. I think it's time my cardiologist and I had a little discussion, particularly about device options next year.

Additionally, do you see any device settings that might help my present situation? My last PM interrogation revealed about a year of battery live remaining.

Appreciate your advise!

Thanks again!

by greyfox - 2015-09-04 05:09:48

Okay, worth a try. I just came off a rolling hills, Colorado ride of 48 miles and my ave HR was 88 bpm. I told the three people I was riding with not to slow when I fell behind coming up on the hills. As long as I could see them, I could stay on track. I did find out one thing though, the Tarzan chest beating doesn't do that much and makes for safety compromised riding. I think the challenge will be getting my cardiologist and the Medtronic's tech to take the time. My wife's response was, "well, that's the time you shop for a new cardiologist."

Rate response

by golden_snitch - 2015-09-04 05:09:57

Hi!

You can have the motion sensor's "sensitivity" programmed to be very high, but keep in mind that this will most likely lead to overreaction whenever you walk, drive on bumpy roads etc. And actually, I doubt that this would help with your cycling issues since there will still be no upper body movement.

But what you can do is the following: Make an appointment for a change of settings + a bicycle ergometry or you bring your own bike, so that you can take a quick ride after settings have been changed. That gives you the chance to try the new setting and have it changed again (and try this again), if it doesn't work. It's a bit time consuming - and you need a patient cardio for this who is willing to optimize settings -, but better than having to make one appointment after another. I remember that my Medtronic pacemaker had kind of an exercise test that one could activate. For about 15 minutes it would record a heart rate curve that also indicates what the sensor did and how much your own intrinsic rhythm did. My cardio used this often. He activated the test, then had me walk the stairs or take a quick stroll, then looked at the newly generated data and, if needed, made some more adjustments.

As I said, you might find out that changing the sensitivity does not help with your cycling issues, but it's still worth a try.

Good luck!

Cycling

by advracer - 2015-09-05 01:09:39

Like Inga said you're wasting your time if you think you can get an accelerometer only pm to work for road biking.
I had a medtronics pm and had the exact same problem as you with biking, even worse when running. I had that pm for a year and then switched it out for a Boston Scientific minute ventilation model. Biking is just about back to normal and running is fantastic.
Bottom line is that the docs have very, very little experience with athletes and will more than likely implant a device that they implant in 99% of their patients, the docs have really no idea how pm's work for athletic, active people, and don't really care as long as you walk away alive they figure that's a win.
Only YOU care about your lifestyle do do some research before you replace your pm.

T

Ultrapacer

by greyfox - 2015-09-05 02:09:26

From your reply, I'm inferring that your PM is accelerometer only device? Do you have any details on the adjustments you received?

Ultrpacer

by ultrapacer - 2015-09-05 03:09:12

I bike and run ultra marathons and say for sure get it adjusted. It took me many tries to find just the right setting but I did. As previously noted on your road bike, especially if you are good, there is little upper body motion. As your heart rate increases your PM notes increased heart rate and little motion so,it slows you down. For me this felt as if all of a sudden I was riding through mud. I was able to get it adjusted and now I run and ride just fine. Dont give up. Be persistent.

Ultrapacer

by greyfox - 2015-09-05 06:09:22

Yes, my PM is an accelerometer only device. No details except to that the Medtronics tech during my last check said the rate response was working properly and was set at a fair quick setting.

I'll be 70 when this unit is swapped out in about a year. Since I'm on medicare, and a good supplemental, will it be difficult to justify to the insurance gods the added cost of a PM with accelerometer and respirator monitoring?

Ultrapacer

by ultrapacer - 2015-09-06 03:09:07

I have many issues yet still cycle well and run ultra marathons albeit a bit slower than in the past. I'm 62. Next time I go in ill ask for setting info that may be transferable

Ultrapacer

by ultrapacer - 2015-09-06 03:09:42

I have many issues yet still cycle well and run ultra marathons albeit a bit slower than in the past. I'm 62. Next time I go in ill ask for setting info that may be transferable

Be persistent. Do not give up until you get help

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