Patent ID: 7941216

Claim:
A method, comprising: identifying a vulnerable ventricular region in a patient that is predisposed to becoming ischemic; implanting a cardiac pacing device having first and second electrodes; implanting the first electrode near the ventricular region vulnerable to ischemia so that a pacing pulse from the first electrode unloads the vulnerable region during systole as compared with an intrinsic beat; implanting the second electrode near a ventricular region remote from the vulnerable region so that a pacing pulse from the second electrode loads the vulnerable region during systole as compared with an intrinsic beat; configuring the device to operate in a vulnerable region unloading mode that delivers pacing pulses in accordance with an atrial tracking or AV sequential pacing mode with a specified AV delay interval through a pacing channel configured with the first electrode, a vulnerable region loading mode that delivers pacing pulses in accordance with an atrial tracking or AV sequential pacing mode with a specified AV delay interval through a pacing channel configured with the second electrode, or a normal mode that delivers no pacing pulses to either the first or second electrodes; configuring the device to sense a variable related to the patient's exertion level; configuring the device to sense a variable that can be correlated with the occurrence of myocardial ischemia and to detect the presence or absence of myocardial ischemia in accordance with the sensed variable; configuring the device to intermittently switch from the normal mode to the vulnerable region loading mode according to a defined schedule if the sensed variable indicates the absence of myocardial ischemia; configuring the device to switch from either the normal mode or the vulnerable region loading mode to the vulnerable region unloading mode if the sensed variable indicates the presence of myocardial ischemia; configuring the device to dynamically shorten the AV delay in accordance with measured exertion level in the vulnerable region loading mode; and, configuring the device to dynamically shorten the AV delay in accordance with the sensed variable correlated with ischemia in the vulnerable region unloading mode.