Abstract:
Disclosed herein is a system for monitoring a motion of a cardiac tissue. The system includes a motion sensor configured to operably couple to the cardiac tissue. The motion sensor includes an electroactive polymer and is further configured to result in a deflection in the electroactive polymer when the cardiac tissue undergoes the motion. The deflection in the electroactive polymer generates an electrical event.

Description:
FIELD OF THE INVENTION 
       [0001]    The present invention relates to medical devices and methods. More specifically, the present invention relates to devices and methods associated with sensing and causing cardiac function. 
       BACKGROUND OF THE INVENTION 
       [0002]    Congestive heart failure (CHF) or a myocardial infarction can result in heart tissue that is incapable of contributing to the pumping action of the heart. Where heart tissue damage is severe from the CHF or myocardial infarction, the affected heart tissue will even be non-responsive to pacing therapy provided via an implanted pulse generator such as, for example, a pacemaker or implantable cardioverter defibrillator (ICD). 
         [0003]    Pacing and defibrillation therapies provided via an implantable pulse generator require the sensing of the natural cardiac electrical signals and the pulse generator administered electrical signals. For example, implantable medical leads extend from the pulse generator implanted in the patient&#39;s upper chest to locations within the patient&#39;s heart, for example, the right ventricle, right atrium and coronary sinus. The distal region of each lead includes electrodes for pacing and/or defibrillation. Also, the distal region of each lead further includes electrodes for sensing the natural cardiac and administered electrical signals. The pulse generator analyzes these sensed electrical signals to determine the how to administer the electrotherapy via the pacing and/or defibrillation electrodes. 
         [0004]    Unfortunately, the sensing electrodes may sense electrical noise and far-field signals, which can mislead the analysis by the pulse generator. As a result, the pulse generator can administer inappropriate electrotherapy to the patient&#39;s heart, potentially leading to life threatening cardiac conditions. 
         [0005]    There is a need in the art for systems, devices and methods for addressing the above-mentioned shortcomings. 
       BRIEF SUMMARY OF THE INVENTION 
       [0006]    Disclosed herein is a system for monitoring a motion of a cardiac tissue. In a first embodiment, the system includes a motion sensor configured to operably couple to the cardiac tissue. The motion sensor includes an electroactive polymer and is further configured to result in a deflection in the electroactive polymer when the cardiac tissue undergoes the motion. The deflection in the electroactive polymer generates an electrical event. The electrical event may include an electrical potential. 
         [0007]    In a first version of the first embodiment of the system, the system may further include an implantable medical lead on which the motion sensor is supported, the lead being at least partially responsible for the motion sensor being operably coupled to the cardiac tissue. The lead may include a distal helical anchor configured to actively attach to the cardiac tissue, the anchor being at least partially responsible for the motion sensor being operably coupled to the cardiac tissue. The first version of the first embodiment of the system may yet further include a device electrically coupled to the motion sensor via the lead, the device configured to detect the electrical event and determine a characteristic of the cardiac motion from the electrical event. The characteristic may include heart rate, contractility, contractile velocity, or heart chamber contractile timing (i.e., A to V or V to V timing). The device may include an implantable pulse generator. 
         [0008]    In a second version of the first embodiment of the system, the system may further include a substrate on which the motion sensor is supported, the substrate being at least partially responsible for the motion sensor being operably coupled to the cardiac tissue. The substrate may include a surface patch configured to be applied to the cardiac tissue. The surface patch may include at least one of an adhesive configured for cardiac tissue adherence or a mesh configured for cardiac tissue ingrowth. Alternatively or additionally, the surface patch may be at least one of configured to suture or staple to the cardiac tissue. The surface patch may have a shape that is generally rectangular, circular or cross-shaped. The second version of the first embodiment of the system may further include a lead and a device electrically coupled to the motion sensor via the lead, the device configured to detect the electrical event and determine a characteristic of the cardiac motion from the electrical event. The characteristic may include heart rate, contractility, contractile velocity, or heart chamber contractile timing (i.e., A to V or V to V timing). The device may include an implantable pulse generator. 
         [0009]    In a third version of the first embodiment of the system, the system may further include a motion causing assembly configured to operably couple to the cardiac tissue and including an electroactive polymer that deflects upon being subjected to an electrical potential. The deflection of the electroactive polymer results in deflection of the motion causing assembly, thereby causing motion in the cardiac tissue operably coupled to the motion causing assembly. Thus, in some instances, the motion causing assembly may be considered a cardiac compression device, which when actuated, results in the compression of the region of the heart to which the motion causing assembly is operably coupled. The motion causing assembly may include a substrate on which the motion causing assembly is supported, the substrate being at least partially responsible for the motion causing assembly being operably coupled to the cardiac tissue. The substrate may include a surface patch configured to be applied to the cardiac tissue. The surface patch may include at least one of an adhesive configured for cardiac tissue adherence or a mesh configured for cardiac tissue ingrowth. Alternatively or additionally, the surface patch may be at least one of configured to suture or staple to the cardiac tissue. The third version of the first embodiment of the system may further include a lead and a device electrically coupled to the motion causing assembly via the lead, the device configured to generate the electrical potential. The device may include an implantable pulse generator. 
         [0010]    Also disclosed herein is a method of monitoring a motion of a cardiac tissue. In a first embodiment, the method includes: operably coupling a motion sensor to the cardiac tissue in such a manner that motion of the cardiac tissue deflects an electroactive polymer of the motion sensor; and detecting an electrical event generated by deflection of the electroactive polymer. The electrical event may include an electrical potential. The first embodiment of the method may further include analyzing the detected electrical event to determine a characteristic of the cardiac motion from the electrical event. The characteristic may include heart rate, contractility, contractile velocity, or heart chamber contractile timing (i.e., A to V or V to V timing). The first embodiment of the method may additionally or alternatively include: operably coupling a motion causing assembly to the cardiac tissue; and subjecting an electroactive polymer of the motion causing assembly to an electrical potential, the deflection of the electroactive polymer resulting in deflection of the motion causing assembly, thereby causing motion in the cardiac tissue operably coupled to the motion causing assembly. 
         [0011]    While multiple embodiments are disclosed, still other embodiments of the present invention will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative embodiments of the invention. As will be realized, the invention is capable of modifications in various aspects, all without departing from the spirit and scope of the present invention. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not restrictive. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0012]      FIG. 1  is an anterior view of a heart shown in partial cross section with a cardiac motion sensing system coupled to the heart. 
           [0013]      FIG. 2  is an isometric view of a section of a body of a lead depicted in  FIG. 1 , wherein an EAP sensor in a strip configuration is supported on the lead body. 
           [0014]      FIG. 3  is an isometric view of a section of a body of a lead depicted in  FIG. 1 , wherein an EAP sensor in a semi-cylindrical configuration is supported on the lead body. 
           [0015]      FIG. 4  is an isometric view of a section of a body of a lead depicted in  FIG. 1 , wherein an EAP sensor in a cylindrical configuration is supported on the lead body. 
           [0016]      FIG. 5  is an anterior view of a heart with a another cardiac motion sensing system coupled to the heart. 
           [0017]      FIG. 6  is an isometric view of a patch-shaped EAP sensor as may be employed according to  FIG. 5 . 
           [0018]      FIG. 7  is an isometric view of a strip-shaped EAP sensor as may be employed according to  FIG. 5 . 
           [0019]      FIG. 8  is an isometric view of a cross-shaped EAP sensor as may be employed according to  FIG. 5 . 
           [0020]      FIG. 9  is a cross section elevation of an EAP sensor and a schematic wiring diagram extending therefrom. 
           [0021]      FIG. 10  is an anterior view of a heart with a cardiac compression system coupled to the heart. 
       
    
    
     DETAILED DESCRIPTION 
       [0022]    Disclosed herein are medical devices employing electroactive polymer (EAP) to sense cardiac motion and/or cause cardiac compression. In one embodiment, an EAP equipped device can be coupled to heart tissue such that heart contractions will cause the EAP to flex, resulting in the generation of an electrical potential or charge that can be sensed and analyzed to determine cardiac operational characteristics such as, for example, heart rate and contractility. These cardiac operational characteristics can then be used to identify cardiac conditions such as, for example, ventricular tachycardia or ventricular fibrillation. 
         [0023]    In another embodiment, an EAP equipped device can be coupled to heart tissue such that an electrical signal delivered to the EAP will cause the EAP equipped device to compress the heart tissue, causing a cardiac compression. Where such an EAP equipped device is coupled to heart tissue encompassing a myocardial infarction, the region of the myocardial infarction may be caused to contribute in the cardiac compression where traditional pacing-only therapies would fail to do so. 
         [0024]    For a discussion of one embodiment of an EAP equipped device configured to sense cardiac motion, reference is made to  FIG. 1 , which is an anterior view of a heart  12  shown in partial cross section with a cardiac motion sensing system  5  coupled to the heart. As shown in  FIG. 1 , the system  5  includes an implantable pulse generator  10  such as, for example, a pacemaker or ICD and one or more EAP equipped implantable leads  20 ,  24 ,  30 . A distal region of a lead may include one or more of the following items: a tip electrode  22 ,  26 ,  32 , a ring electrode  23 ,  27 ,  34  proximal the tip electrode, and a defibrillation or shock coil  28 ,  36 ,  38  proximal the ring electrode. 
         [0025]    A lead may be configured for passive fixation in the heart  12 . In one embodiment, a distal region of a lead may be configured for passive fixation such as, for example, the lead body being configured to bias against the walls of the coronary sinus to passively maintain the lead in place. In one embodiment, the distal tip of a lead may be configured for passive fixation such as, for example, the lead distal tip having pliable tines radiating from the lead distal tip. In embodiments where the lead is configured for passive fixation, the tip electrode  22 ,  26 ,  32  may be in the form of a ring or semi-spherical dome. 
         [0026]    The lead may be configured for active fixation. In one embodiment, a distal tip of a lead may be configured for active fixation, wherein the tip electrode  22 ,  26 ,  32  is in the form of a helical anchor electrode that allows the electrode to be screwed into cardiac tissue. 
         [0027]    A proximal end of each lead  20 ,  24 ,  30  is coupled to the pulse generator  10  and the leads extend distally into the heart  12 . For example, one lead  20  may extend from the pulse generator into the right atrium  40  where the lead tip electrode  22  is passively or actively fixed to a wall of the right atrium. Another lead  24  may extend from the pulse generator, through the right atrium, the coronary sinus ostium (OS)  42 , and the coronary sinus  44 , and into the left coronary vein  46 . Yet another lead  30  may extend form the pulse generator, through the right atrium and tricuspid annulus  47  and into the right ventricle  48 , the tip electrode  32  passively or actively fixed to the wall of the right ventricle near the right ventricular apex  50 . 
         [0028]    As indicated in  FIG. 1 , a lead  20 ,  24 ,  30  includes an EAP sensor  52 ,  54 ,  57  on the lead body near the lead distal end. The EAP sensor is located on a region of the lead body that is generally most likely to be deflected by cardiac motion when the lead distal end is fixed to a desired fixation location in the heart  12 . For example, for lead  30 , which has its lead distal end fixed to cardiac tissue near the right ventricular apex  50 , the EAP sensor  54  is located on the lead body proximal the lead&#39;s three most distal electrodes  32 ,  34 ,  36 , but still located in the right ventricle  48  at a location on the lead body that is likely to deflect when the right ventricle compresses. For another example, for lead  20 , which has its lead distal end fixed to cardiac tissue in the right atrium  40  near the OS  42 , the EAP sensor  52  is located on the lead body proximal the lead&#39;s electrodes  22 ,  23 , but still located in the right atrium  40  at a location on the lead body that is likely to deflect when the right atrium compresses. For yet another example, for lead  24 , which has its lead distal end fixed to cardiac tissue in the left coronary vein  46 , the EAP sensor  57  is located on the lead body proximal the lead&#39;s two most distal electrodes  26 ,  27 , but still located in the coronary sinus  44  or left coronary vein  46  at a location on the lead body that is likely to deflect when the left ventricle compresses. 
         [0029]    Depending on the embodiment, an EAP equipped lead will have any one or more of the different types of the above-mentioned electrodes/coils and the EAP equipped lead will have one or more EAP sensors located on the lead body at any one or more locations that are generally likely to undergo the most deflection once the lead is implanted. An EAP sensor can be located at a variety of locations on an EAP equipped lead, and the examples discussed above are purely for illustrative purposes and not intended to limit the possibilities with respect to EAP sensor number or placement on a lead body. An EAP equipped lead with any of the electrode configurations discussed above may be employed with a variety of standard (i.e., non-EAP equipped) pacing leads in a variety of commonly employed lead placement strategies. 
         [0030]    In some embodiments, an EAP equipped lead will have none of the above listed electrodes and will simply be a structure on which one or more EAP sensors may be mounted. Such an EAP sensor only type lead may be employed with a variety of standard (i.e., non-EAP equipped) pacing leads in a variety of commonly employed lead placement strategies. 
         [0031]    For a discussion of some example embodiments for lead based EAP sensors  60  that can be employed on lead bodies as discussed above with respect to  FIG. 1 , reference is made to  FIGS. 2 ,  3  and  4 , which are isometric views of a section of a lead body  62 . As shown in  FIG. 2 , in one embodiment, an EAP sensor  60  may be in the form of a strip extending longitudinally along a length of the lead body  62 . In one embodiment, such an EAP sensor  60  has a length of between approximately 5 mm and approximately 80 mm and a width that is between approximately 5 percent and 50 percent of the outer circumference of the lead body  62 . While the EAP sensor  60  is illustrated in  FIG. 2  as being on or forming part of the outer circumferential surface  64  of the lead body, in some embodiments, the EAP sensor  60  is imbedded in the lead body  62  below the outer circumferential surface  64 . A segment length of a lead body  62  may have one or more such strip-type EAP sensors  60  located about the outer circumferential surface  64  of the lead body  62 . For example, such strip-type EAP sensors  60  could be located at 12, 3, 6 and 9 o&#39;clock about the outer circumference of the lead body. 
         [0032]    As shown in  FIGS. 3 and 4 , in one embodiment, an EAP sensor  60  may be in the form of a partial or complete cylinder extending longitudinally along a length of the lead body  62 . In one embodiment, such an EAP sensor  60  has a length of between approximately 5 mm and approximately 80 mm. As illustrated in  FIG. 4 , in one embodiment, the EAP sensor  60  is a complete cylinder extending uninterrupted about the outer circumference of the lead body. As depicted in  FIG. 3 , in one embodiment, the EAP sensor  60  is a semi-cylinder partially extending about the outer circumference of the lead body between approximately 10 percent and 50 percent of the outer circumference of the lead body  62 . While the EAP sensor  60  is illustrated in  FIGS. 3 and 4  as being on or forming part of the outer circumferential surface  64  of the lead body, in some embodiments, the EAP sensor  60  is imbedded in the lead body  62  below the outer circumferential surface  64 . 
         [0033]    For a discussion of another embodiment of an EAP equipped device configured to sense cardiac motion, reference is made to  FIG. 5 , which is an anterior view of a heart  12  with a cardiac motion sensing system  5  coupled to the heart. As shown in  FIG. 5 , the system  5  includes an implantable pulse generator  10  and one or more EAP equipped implantable devices  70  configured for placement on the outer surface  72  of the heart  12 . For example, in one embodiment, the EAP equipped surface mountable sensors  70  are implanted on the heart outer epicardial surface  72  in the pericardial space  74  defined between the heart outer epicardial surface  72  and the interior surface of the pericardial sac  76 . A lead  78  having electrical conductors insulated therein extends proximally from each EAP equipped surface mountable device  70  to the pulse generator  10 . 
         [0034]    The devices  70  and leads  78  can be delivered minimally invasively via a subxyphoid access and punctures  80  in the pericardial sac  76 . Each device  70  can be secured to the heart outer surface  72  via a variety of methods including, for example, adhesive, suture, screwed-in anchors, configurations that facilitate the device  70  being wedged into place to mechanically, forceably hold the device in place, and inflammatory response for causing tissue in-growth of cardiac tissue cells into a polyester mesh forming part of the device  70 . 
         [0035]    In some embodiments, the devices  70  are implanted on the outer surface of the pericardial sac  76 . In some embodiments, the devices  70  include electrodes mounted thereon for providing pacing and/or defibrillation shocking. 
         [0036]    As indicated in  FIG. 5 , the EAP equipped device  70  is located on a region of the outer surface  72  of the heart  12  where movement of the heart surface  72  is generally most likely to cause the device  70  to deform, displace or deflect in a manner that will cause the EAP of the device  70  to create an electrical signal that can be detected and analyzed by the pulse generator  10 . For example, a device  70  may be mounted on the outer surface of the right atrium  40 , as indicated at A. Alternatively or additionally, a device  70  may be mounted on the outer surface of the right ventricle  48 , as indicated at B. Alternatively or additionally, a device  70  may be mounted on the outer surface of the left atrium  82 , as indicated at C. Alternatively or additionally, a device  70  may be mounted on the outer surface of the left ventricle  84 , as indicated at D. Of course, the device(s)  70  can be located on other regions of the heart outer surface  72 , and the locations A-D are provided merely as non-limiting examples. 
         [0037]    For a discussion of some example embodiments for EAP sensors  70  that are configured for mounting on a heart outer surface  72  as discussed above with respect to  FIG. 5 , reference is made to  FIGS. 6 ,  7  and  8 , which are isometric views of such sensors  70 . As shown in  FIG. 6 , in one embodiment, an EAP sensor  70  may be in the form of a sheet or patch that is square, rectangular, triangular, circular, oval, or etc. and from which a lead  78  extends for coupling to the pulse generator  10 . In a rectangular version of the EAP patch  70  of  FIG. 6 , the patch  70  has a length of between approximately 10 mm and approximately 40 mm and a width between approximately 5 mm and 25 mm. 
         [0038]    As shown in  FIG. 7 , in one embodiment, an EAP sensor  70  may be in the form of a strip from which a lead  78  extends for coupling to the pulse generator  10 . In one version of the EAP strip  70  of  FIG. 7 , the strip  70  has a length of between approximately 10 mm and approximately 50 mm and a width between approximately 1 mm and 15 mm. 
         [0039]    As shown in  FIG. 8 , in one embodiment, an EAP sensor  70  may be in the form of a cross from which a lead  78  extends for coupling to the pulse generator  10 . In one version of the EAP cross  70  of  FIG. 8 , the cross  70  arms have lengths from the cross intersection of between approximately 5 mm and approximately 40 mm, and the cross arms  70  have widths between approximately 2 mm and 20 mm. Of course, the configurations given in  FIGS. 6 ,  7  and  8  are merely non-limiting examples, and other configurations are possible and should be considered as being part of the scope of this disclosure. 
         [0040]    For each of the embodiments depicted in  FIGS. 6 ,  7  and  8 , the EAP sensor  70  includes an upper surface  86  and a bottom surface  88 . The upper surface  86  includes or supports the EAP material, and the bottom surface  88  is configured to generally conform to the outer heart surface  72  when the EAP sensor is applied to the outer heart surface. In one embodiment, the bottom surface includes an adhesive for adhering the EAP sensor to the heart surface. In one embodiment, the bottom surface includes a polyester mesh or other material such as, for example, fibrin matrix or ePTFE, for causing inflammatory response that causes heart surface cells to in-grow into the mesh, thereby securing the EAP sensor  70  to the heart surface. In some embodiments, the EAP sensor is configured to be sutured, anchor screwed, wedged into place to mechanically, forceably hold the device in place, or otherwise mechanically anchored to the heart tissue. 
         [0041]    For a discussion of an EAP sensor configuration  90  that may be employed as part of any of the EAP sensors  60 ,  70  discussed above with respect to  FIGS. 2-4  and  6 - 8 , reference is made to  FIG. 9 , which is a cross section elevation of an EAP sensor configuration  90  and a schematic wiring diagram  92  extending therefrom. In one embodiment, as can be understood from  FIG. 10 , the EAP sensor configuration  90  employs an Ionomeric Polymer-Metal Composite (IPMC)  94  or another ionic EAP. A typical IPMC includes a thin (200 μm thick) polymer membrane  96  with metal electrodes  98  (5-10 μm thick) plated to both faces. The polyelectrolyte is neutralized with counter-ions, balancing the charge of the anions covalently fixed to the membrane  96 . When an IPMC is hydrated and stimulated by a small voltage (1-5 V), both the fixed anions and the mobile counter-ions are subjected to the electric field. The counter-ions diffuse towards one of the electrodes and, as a result, the composite undergoes a fast bending deformation toward the anode. The bending is the result of increased stiffness along the cathode and decreased stiffness along the anode. Reversing the process, i.e., bending the IPMC instead of applying electricity to the IPMC, generates an electrical potential difference similar to electrical potential differences that arise in traditional piezoelectric-like behavior. 
         [0042]    Current methods for IPMC manufacture rely on noble metals such as platinum and gold. Nafion® and Flemion® are common base polymers. The permselective properties of ionomeric resins allow selective reduction of metal salts at the surface of ion exchange membranes making polymer-metal composites that are not prone to delamination. 
         [0043]    As indicated in  FIG. 9 , in one embodiment, a power conductor  100  and a ground conductor  102  extend from respective electrodes  98  of the EAP sensor configuration  90  within an electrically insulated lead body  104  to the pulse generator  10 , as discussed above with respect to  FIGS. 1 and 5 . As can be understood from  FIG. 9  and the preceding discussion regarding  FIGS. 1-8 , when the EAP sensor is secured to the heart tissue such that movement of the heart tissue cause a bending, flexing, deflection or any other deformation of the EAP configuration  90 , an electrical potential difference is generated by the EAP configuration  90  that is transmitted to the pulse generator  10  via the conductors  100 ,  102  contained in the lead body  104 . The pulse generator  10 , or any other device electrically coupled to the EAP configuration and having algorithms for analyzing the EAP generated electrical potential difference, deciphers the electrical potential difference with respect to such example parameters as rate and magnitude. Such example parameters can be deciphered and monitored to determine such example cardiac characteristics as heart rate and contractility. In other words, the rate of the EAP flexion can be correlated with the heart rate, and the magnitude of the flexion can be correlated with contractility. These characteristics can be employed to diagnose cardiac conditions such as, for example, Ventricular tachycardia (VT) and Ventricular Fibrillation (VF). 
         [0044]    In one embodiment, an EAP sensor as described above with respect to  FIGS. 1-9  may be secured to a heart surface that is subject to regular flexion caused by the cardiac cycle. Thus, a variety of sensor locations are possible besides those indicated in  FIGS. 1 and 5 . 
         [0045]    The wiring diagram  92  depicted in  FIG. 9  illustrates a bipolar configuration. In some embodiments, wiring diagram  92  coupling the EAP configuration  90  to the pulse generator  10  may have a unipolar configuration. 
         [0046]    The EAP sensors disclosed herein detect cardiac motion, which is used to determine heart rate, contractility, etc. Thus, unlike the sensing electrodes of leads, which relying on the sensing of electrical signals, the EAP sensors are less susceptible to electrical noise and far-field signal contributions than conventional electrical sensing. 
         [0047]    For a discussion of one embodiment of an EAP equipped device configured to cause cardiac compression, reference is made to  FIG. 10 , which is an anterior view of a heart  12  with a cardiac compression system  120  coupled to the heart. As shown in  FIG. 10 , the system  120  includes an EAP compression device  122  and an implantable pulse generator  10  such as, for example, a pacemaker or ICD. The system may also include implantable leads similar to those discussed above with respect to  FIG. 1  and/or conventional implantable leads. The system may also include EAP sensors  70  similar to those discussed above with respect to  FIG. 5 . 
         [0048]    As can be understood from  FIG. 10 , the EAP compression device  122  extends about at least a portion of the outer surface of the heart, for example, in the pericardial space. The device  122  may be in the form of a pouch, harness or sack that envelops or encloses a substantial portion of the heart. For example, as shown in  FIG. 10 , the EAP compression harness  122  may extend around the right ventricle  48  and left ventricle  84 . The compression harness  122  may be segmented. For example, the harness  122  may include a right portion  124  and a left portion  126  that are mechanically coupled together as part of the overall harness  122 , but electrically isolated such that the right portion  124  and left portions  126  can be triggered separately to separately compress the ventricles  48 ,  84  as needed to achieve a mechanically actuated heart function that is similar to natural heart function. An electrical pacing signal sent to the compression harness  122  causes the EAP imbedded in the harness to flex, causing the harness  122  to artificially compress the heart regions enclosed by the harness  122 . The pacing can be driven be the pulse generator  10  similar to conventional electrical pacing as known in the art. 
         [0049]    Alternatively, the device  122  may be in the form of a patch or sheet that extends over a selected portion of the heart surface, but does not encompass or extend about the heart. For example, the sheet  122  may be secured over a region of the heart having an infarction, which benefits from both the reinforcement of the sheet  122  and the compression of the sheet as a pacing signal is delivered to the EAP imbedded in the sheet  122 . 
         [0050]    In some embodiments, EAP sensors on leads (as discussed with respect to  FIGS. 1-5 ) and/or on patches or similar configurations (as discussed with respect to  FIGS. 6-8 ) may be employed with the compression device  122  discussed with respect to  FIG. 10 . In such an embodiment, both the cardiac compression pacing and the compression sensing can be achieved without the electrical pacing and sensing common in the art. 
         [0051]    Although the present invention has been described with reference to preferred embodiments, persons skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention.