Patent ID: 8369948

Claim:
A cardiac pacing device, comprising: sensing and pulse generation circuitry for connecting to one or more sensing/pacing electrodes disposed in proximity to a stressed region of the myocardium; an exertion level sensor; a controller for controlling the delivery of pacing pulses; wherein the controller is programmed to deliver pacing therapy to a first pacing site in a manner such that the stressed region of the myocardium is excited before other regions of the myocardium in order to subject the stressed region to less mechanical stress when the myocardium contracts; wherein the controller is programmed to measure the patient's exertion level with the exertion level sensor; and, wherein the controller is programmed to alternate between a pulse output sequence that pre-excites the stressed region and a pulse output sequence that does not in accordance with the exertion level measurement such that pre-excitation of the stressed region is discontinued during periods of increased exertion.