# US 2014/0194941 A1 · Method and apparatus for intrachamber resynchronization > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2014/0194941 A1 - Document ID: US20140194941A1 - Status: Published application - Kind: A1 - Application number: 14/206,111 - Filed: 2014-03-12 - Published: 2014-07-10 - Earliest claimed: 2003-09-08 - Assignees: Mirowski Family Ventures, L.L.C. - Applicants: Mirowski Family Ventures, LLC - Inventors: Morton M. MOWER - Web page: https://patentgrep.com/patent/US20140194941A1 ## CPC - A61N 1/3627: {for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy} - A61N 1/36592: {controlled by the heart rate variability} - A61N 1/36842: {Multi-site stimulation in the same chamber} - A61N 1/36843: {Bi-ventricular stimulation} - A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B) ## Abstract Methods, apparatus, and systems are provided to control contraction of the heart. At least one sensing element receives signals indicating electrical activity of sinus rhythm of the heart. Based on the received signals, the progress of contraction of the heart is determined. Based on the progress of contraction, the chamber of the heart may then be stimulated at a plurality of locations. In another embodiment, a plurality of electrodes are implanted in the left ventricle to stimulate at multiple locations in the left ventricle for the purpose of improving hemodynamic performance and increasing cardiac output in a patient who is suffering from congestive heart failure. ## Claims ### Claim 1 (canceled) ### Claim 2 Circuitry to improve hemodynamic efficiency of a human heart comprising: a first electrode disposed about a left ventricle to sense an intrinsic signal that stimulates said left ventricle; a second electrode disposed about said left ventricle and spaced apart from said first electrode to sense said intrinsic signal; a comparison circuit to compare said intrinsic signal as sensed by said first and second electrodes to determine if propagation of said intrinsic signal throughout said left ventricle is below a predetermined threshold level; and a generator circuit to generate an additional signal to stimulate said left ventricle through said first and second electrodes if said propagation of said intrinsic signal is below said predetermined threshold level. ### Claim 3 (depends on 2) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 2 further comprising: a first right ventricle electrode disposed about a right ventricle to sense a right ventricle intrinsic signal that stimulates said right ventricle; and a second right ventricle electrode disposed about said right ventricle and spaced apart from said first right ventricle electrode to sense said right ventricle intrinsic signal, wherein the comparison circuit is further configured to compare said right ventricle intrinsic signal as sensed by said first and second right ventricle electrodes to determine if propagation of said right ventricle intrinsic signal throughout said right ventricle is below a right ventricle predetermined threshold level, and the generator circuit is further configured to generate an additional signal to stimulate said right ventricle through said first and second right ventricle electrodes if said propagation of said right ventricle intrinsic signal is below said right ventricle predetermined threshold level. ### Claim 4 (depends on 3) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 3 further comprising: at least one atrial electrode disposed about a right atrium of the heart to sense said intrinsic signal and to provide the intrinsic signal to the comparison circuit, wherein the comparison circuit further compares the intrinsic signal sensed in the right atrium with the intrinsic signals sensed in the right and left ventricles, respectively to determine if propagation of the intrinsic signal to the right and left ventricles occurs within a predetermined time period of sensing the intrinsic signal in the right atrium. ### Claim 5 (depends on 3) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 3, wherein the generator is further configured to generate one or more signals to stimulate at least one of the right ventricle and the left ventricle based on whether propagation of the intrinsic signal to the right and left ventricles occurs within the predetermined time period. ### Claim 6 (depends on 5) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 5, wherein the first and second electrodes, the first and second right ventricle electrodes, and the at least one atrial electrode are helical coil electrodes. ### Claim 7 (depends on 3) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 3, wherein the comparison circuit is further configured to generate a signal to provide stimulation to the left ventricle after a predetermined time delay from the sensing of the intrinsic signal in the right ventricle. ### Claim 8 (depends on 2) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 2, further comprising: a telemetry circuit configured to communicate with an external device to transmit diagnostic information concerning said heart to an external device. ### Claim 9 (depends on 8) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 8, wherein the diagnostic information includes data representative of the intrinsic signal sensed by the first and second electrodes, and data representative of the additional signal generated by the generator circuit. ### Claim 10 (depends on 8) Circuitry to improve hemodynamic efficiency of a human heart as set for in claim 8, wherein the telemetry circuit transmits the diagnostic information via radio waves. ### Claim 11 (depends on 3) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 3, wherein the generator circuit is configured to generate additional signals to provide stimulation to both the right and left ventricles using a predetermined timing sequence. ### Claim 12 (depends on 11) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 11, wherein additional signals that provide stimulation to the right ventricle differ from additional signals that provide stimulation to the left ventricle in at least duration or amplitude. ### Claim 13 (depends on 3) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 3, wherein the generator circuit is a one-shot circuit. ### Claim 14 (depends on 2) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 2, wherein at least one of the first and second electrodes is disposed in a ventricular septum. ### Claim 15 (depends on 2) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 2, wherein the generator circuit is further configured to generate a pre-excitation signal delivered to the left ventricle via at least one of the first and second electrodes to regulate a contraction of the left ventricle. ### Claim 16 (depends on 15) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 15, wherein the pre-excitation signal has a voltage level lower than a voltage level required to cause depolarization and contraction of muscle tissue of the left ventricle. ### Claim 17 (depends on 16) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 16, wherein the pre-excitation signal has a positive polarity to accelerate contraction of the muscle tissue of the left ventricle. ### Claim 18 (depends on 16) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 16, wherein the pre-excitation signal has a negative polarity to slow contraction of the muscle tissue of the left ventricle. ### Claim 19 (depends on 16) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 16, wherein the pre-excitation signal is applied to the left ventricle via one of the first and second electrodes. ### Claim 20 (depends on 16) Circuitry to improve hemodynamic efficiency of a human heart as set forth in claim 16, wherein the pre-excitation signal is applied to the left ventricle via both the right and the left electrodes simultaneously. ### Claim 21 A method to improve hemodynamic efficiency of a human heart, comprising: sensing an intrinsic signal that stimulates a left ventricle of the heart via a first electrode disposed about the left ventricle; sensing the intrinsic signal via a second electrode disposed about said left ventricle and spaced apart from said first electrode; comparing, in a comparison circuit, said intrinsic signal as sensed by said first and second electrodes to determine if propagation of said intrinsic signal through said left ventricle is below a predetermined threshold level; and generating, with a generator circuit, an additional signal to stimulate said left ventricle through said first and second electrodes if said propagation of said intrinsic signal is below said predetermined threshold level.