Cardiac stimulator for cardiac contractility modulation

1. A cardiac stimulator, comprising

at least three stimulation electrode poles;

at least one electrode lead;

at least one stimulation unit connected to said at least three stimulation electrode poles via said at least one electrode lead;

wherein the at least one stimulation unit is configured to deliver subthreshold stimulation pulses for a cardiac contractility modulation therapy via at least two of the at least three stimulation electrode poles;

at least one sensing unit configured to detect electrical or mechanical actions of the heart and configured to detect signals characteristic of a heart action;

wherein the at least one sensing unit comprises, or is connected to, an evaluation unit configured to evaluate signals detected by the sensing unit, to evaluate a stimulation success or failure of a suprathreshold stimulation for each of said at least three stimulation electrode poles, and to supply a corresponding evaluation result signal; and

a therapy control unit connected to the stimulation unit and the evaluation unit, wherein the evaluation unit forwards said evaluation result signal to said therapy control unit;

wherein the therapy control unit is configured to control a respective cardiac contractility modulation therapy dependent on the corresponding evaluation result signal of the evaluation unit,

wherein the respective cardiac contractility modulation therapy is configured to be activated or deactivated dependent on said stimulation success or failure of said suprathreshold stimulation,

wherein therapy parameters of the respective cardiac contractility modulation therapy are selected and/or adjusted dependent on the respective evaluation result signal;

wherein the respective cardiac contractility modulation therapy is optimized automatically and while in progress,

wherein said therapy control unit optimizes the therapy parameters that are optimal for said respective cardiac contractility modulation therapy,

wherein the evaluation unit evaluates signals detected by the at least one sensing unit after delivery of said suprathreshold stimulation pulse with respect to a success of the stimulation, and supplies a corresponding evaluation result signal; and,

wherein the therapy control unit

deactivates a respective cardiac contractility modulation therapy at least for one respective cardiac cycle if the evaluation result signal does not show any stimulation success; and,

allows a respective cardiac contractility modulation therapy for at least one respective cardiac cycle only if the evaluation result signal shows an effective stimulation in at least one ventricular stimulation site, or all sites being stimulated

wherein the a least one sensing unit is further configured to determine the duration of a repolarization in at least two sites, and,

wherein therapy control unit selects and/or adjusts therapy parameters of the cardiac contractility modulation therapy, such that said therapy parameters that are optimal for said respective cardiac contractility modulation therapy are defined by one or more of

a minimum of repolarization times, in response to said selection and/or adjustment,

a homogenization of the repolarization times, in response to said selection and/or adjustment,

a maximum of a slew rate of an action potential detected by the at least one sensing unit, in response to said selection and/or adjustment,

a homogenization of the slew rates of action potentials detected by the at least one sensing unit, in response to said selection and/or adjustment,

a maximum of an action potential duration of an action potential detected by the at least one sensing unit in response to said selection and/or adjustment, and,

a homogenization of the action potential duration of action potentials detected by the at least one sensing unit, in response to said selection and/or a adjustment.

2. The cardiac stimulator according to claim 1 , wherein the at least one sensing unit is further configured to detect signals characteristic of cardiac action at a respective site, or in a direct vicinity of the at least three stimulation electrode poles.

3. The cardiac stimulator according to claim 2 , wherein the at least one sensing unit is further configured to detect times of a characteristic intrinsic or stimulated cardiac excitation at the at least three stimulation electrode poles.

4. The cardiac stimulator according to claim 3 , further comprising sensing electrode poles, wherein the at least one sensing unit is connected to the sensing electrode poles and is further configured to detect electrical potentials characteristic of cardiac action via the at least three stimulation electrode poles and/or the sensing electrode poles.

5. The cardiac stimulator according to claim 1 , wherein the evaluation unit is further configured to determine a time lag between at least two signals detected by the at least one sensing unit and to supply a corresponding evaluation result signal.

6. The cardiac stimulator according to claim 1 , wherein the evaluation unit is further configured to determine signal characteristics of at least two signals detected by the at least one sensing unit and to supply a corresponding evaluation result signal.

7. The cardiac stimulator according to claim 5 , wherein the therapy control unit is further configured to select two of the at least three stimulation electrode poles for a cardiac contractility modulation therapy that results in balanced intraventricular and/or interventricular depolarization times and/or repolarization times.

8. The cardiac stimulator according to claim 1 , wherein the therapy control unit is further configured to obtain said minimum of repolarization times, in response to said selection and/or adjustment, such that the respective cardiac contractility modulation therapy is optimized with said optimum defined by said minimum of repolarization times.

9. The cardiac stimulator according to claim 1 , wherein the therapy control unit is further configured to obtain said homogenization of the repolarization times, in response to said selection and/or adjustment, such that the respective cardiac contractility modulation therapy is optimized with said optimum defined by said homogenization of the repolarization times.

10. The cardiac stimulator according to claim 1 , wherein the therapy control unit is further configured to obtain said maximum of a slew rate of an action potential detected by the at least one sensing unit, in response to said selection and/or adjustment, such that the respective cardiac contractility modulation therapy is optimized with said optimum defined by said slew rate of said action potential.

11. The cardiac stimulator according to claim 1 , wherein the therapy control unit is further configured to obtain said homogenization of the slew rates of action potentials detected by the at least one sensing unit, in response to said selection and/or adjustment, such that the respective cardiac contractility modulation therapy is optimized with said optimum defined by said homogenization of the slew rates of said action potentials.

12. The cardiac stimulator according to claim 1 , wherein the therapy control unit is further configured to obtain said maximum of an action potential duration of an action potential detected by the at least one sensing unit, in response to said selection and/or adjustment, such that the respective cardiac contractility modulation therapy is optimized with said optimum defined by said maximum of an action potential duration of said action potential.

13. The cardiac stimulator according to claim 1 , wherein the therapy control unit is further configured to obtain said homogenization of the action potential duration of action potentials detected by the at least one sensing unit, in response to said selection and/or adjustment, such that the respective cardiac contractility modulation therapy is optimized with said, optimum defined by said homogenization of the action potential duration of said action potentials.