Patent ID: 8306615

Claim:
A system for pacing a heart having an ischemic region, the system comprising: an implantable medical device including: a sensing circuit configured to sense one or more ischemia-indicating signals and one or more therapy-monitoring signals; an ischemia detector coupled to the sensing circuit, the ischemic detector configured to detect an ischemic state indicative of an occurrence of an ischemic event from the one or more ischemia-indicating signals; a therapy delivery device configured to deliver a chronic therapy and a post-ischemia therapy, the therapy delivery device including a pacing circuit configured to deliver pacing pulses to the heart during the chronic therapy and the post-ischemia therapy; a therapy monitor coupled to the sensing circuit, the therapy monitor configured to produce one or more therapy-monitoring parameters using the one or more therapy-monitoring signals, the one or more therapy-monitoring parameters including at least one post-ischemia therapy-monitoring parameter indicative of effectiveness of the post-ischemia therapy and at least one chronic therapy-monitoring parameter indicative of effectiveness of the chronic therapy; and a controller coupled to the ischemia detector, the therapy delivery device, and the therapy monitor, the controller including: a post-ischemia therapy controller configured to initiate the delivery of the post-ischemia therapy in response to the occurrence of the ischemic event as indicated by the detected ischemic state and to adjust the delivery of the post-ischemia therapy using the detected ischemic state and the at least one post-ischemia therapy-monitoring parameter, the post-ischemic therapy controller including a post-ischemic pacing controller configured to adjust one or more regional pacing parameters of the post-ischemia pacing therapy to provide pre-excitation of the ischemic region to reduce stress and workload of the ischemic region in response to the occurrence of the ischemic event; and a chronic therapy controller configured to adjust the delivery of the chronic therapy using the detected ischemic state and the at least one chronic therapy-monitoring parameter, the chronic therapy controller including a chronic pacing controller configured to adjust one or more global pacing parameters of the chronic therapy to reduce overall workload on the heart in response to the occurrence of the ischemic event.