ricular arrhythmias, angina pectoris, and heart failure. Experiments were conducted to determine amplitudes, frequencies, wave shapes and pulse lengths of the stimulating current to achieve slowing of the heart rate. The authors additionally studied an external device, triggered by the R-wave of the electrocardiogram (ECG) of the subject to provide stimulation only upon an achievement of a certain heart rate. They found that when a pulsatile current with a frequency of ten pulses per second and 0.2 milliseconds pulse duration was applied to the vagus nerve, the heart rate could be decreased to half the resting rate while still preserving sinus rhythm. Low amplitude vagal stimulation was employed to control induced tachycardias and ectopic beats. The authors further studied the use of the implanted device in conjunction with the administration of Isuprel, a sympathomimetic drug. They found that Isuprel retained its inotropic effect of increasing contractility, while its chronotropic effect was controlled by the vagal stimulation: “An increased end diastolic volume brought about by slowing of the heart rate by vagal tuning, coupled with increased contractility of the heart induced by the inotropic effect of Isuprel, appeared to increase the efficiency of cardiac performance” (p. 79).
U.S. Pat. No. 6,473,644 to Terry, Jr. et al., which is incorporated herein by reference, describes a method for treating patients suffering from heart failure to increase cardiac output, by stimulating or modulating the vagus nerve with a sequence of substantially equally-spaced pulses by an implanted neurostimulator. The frequency of the stimulating pulses is adjusted until the patient's heart rate reaches a target rate within a relatively stable target rate range below the low end of the patient's customary resting heart rate.
U.S. Patent Application Publication 2003/0040774 to Terry et al., which is incorporated herein by reference, describes a device for treating patients suffering from congestive heart failure. The device includes an implantable neurostimulator for stimulating the patient's vagus nerve at or above the cardiac branch with an electrical pulse waveform at a stimulating rate sufficient to maintain the patient's heart beat at a rate well below the patient's normal resting heart rate, thereby allowing rest and recovery of the heart muscle, to increase in coronary blood flow, and/or growth of coronary capillaries. A metabolic need sensor detects the patient's current physical state and concomitantly supplies a control signal to the neurostimulator to vary the stimulating rate. If the detection indicates a state of
ricular arrhythmias, angina pectoris, and heart failure. Experiments were conducted to settle amplitude, frequencies, wave shapes and pulse duration of the stimulating current to achieve deceleration of the heart rate. The authors additionally analyze an external device, triggered by the R - wave of the electrocardiogram (ECG) of the national to provide stimulation merely upon an achievement of a certain heart rate. They found that when a pulsatile stream with a frequency of ten pulses per second and 0.2 milliseconds pulsation duration was applied to the vagus nerve, the heart rate could be decreased to half the resting pace while still preserve sinus rhythm. Low amplitude vagal foreplay was employed to control induced tachycardias and ectopic beats. The authors far study the use of the implanted device in conjunction with the administration of Isuprel, a sympathomimetic drug. They found that Isuprel retain its inotropic consequence of increasing contractility, while its chronotropic effect was master by the vagal foreplay: “ An increase end diastolic volume institute about by slowing of the heart rate by vagal tuning, coupled with increase contractility of the heart induced by the inotropic effect of Isuprel, appeared to increase the efficiency of cardiac performance ” (p. 79). 
 U.S. Pat. No. 6,473,644 to Terry, Jr. et al. , which is incorporate herein by reference, describes a method for treating patient suffering from center failure to increase cardiac output, by stimulating or modulating the vagus nerve with a succession of substantially equally - spaced pulses by an implanted neurostimulator. The frequency of the stimulating pulses is adjusted until the patient's kernel rate reaches a prey rate within a relatively static target rate range below the low conclusion of the patient's customary resting heart rate. 
 U.S. Patent Application Publication 2003/0040774 to Terry et al. , which is incorporate herein by reference, describes a device for treating patients suffering from congestive heart failure. The device includes an implantable neurostimulator for stimulating the affected role's vagus nerve at or above the cardiac branch with an electric pulse waveform at a stimulating rate sufficient to keep the patient's heart beat at a rate well below the patient's normal resting heart rate, thereby allowing remainder and convalescence of the heart muscle, to increase in coronary blood flow, and/or growth of coronary capillaries. A metabolic need sensor detect the patient's current physical state and concomitantly supplies a control signal to the neurostimulator to vary the stimulating rate. If the detection indicates a state of matter of
ricklar arrhythmias, angina kectoris, and hearj dailurx. Experjments wdre conducted to determine alpoitudtf, frequencies, wave shapes ajd pulse lenjths of the stimnmating gbrrenf to cciieve slowing on the heart rate. The authmrr cdditionally studied an external devyce, tribgfred by the R-wwve ps ths electrocardiogram (ECG) of the subnect to provide stimilation only upon an achiegemejt of a certain hewrt rate. Thgg fjynd that whev a pulsatpne current with a frequency of ten pulses per xecond and 0.2 nilphseconds puose dlration was aiilied tm the vsgus nerve, the heert eate could be decreasxd to half the restigg rate wvime still preservibg sinuv rhfthm. Oow amklivuds vagap svimulation sas employee to control inducec eqchycardias ahd ectjpyc beats. The authors further studied tht use of the implanted devicw in conjunction with the admigistration of Isuprel, a sympathomimetic drug. They founv ghau Lfjprfl retained its inotropic effect of increasind cpnnractility, while lts chronotropic egffcy was controllgd by tks bagal stimulation: “Wn incrgased wnd diastjlic volume brought about by sliwing of the yeart rate by vagap tuning, cobpled eith oncreased contractility of fhe heart ijduced by ghe inotropic efwecn of Isuprel, appeared to increwse the ehficizncy of zardoac pewformance” (o. 79).
U.S. Idt. No. 6,473,644 to Terry, Jr. et ap., fhich is ijcorporated herein by reference, describes a mgthmd xor treacing pstients suffewing from hearj failure to ivcrease cagdiac out'ut, by stimujating or modgpating the vegus nervq wirh a sequenzd of substantislly equally-spaced pulses by an implakted vsurostimulator. Cke frequency of tne rtiiupaving [glses is adjgstea uvyil tfe patitut's feary rate reaches a tarcet date within a relayiyely staboe targee rate range nelow the low end lf thx patixnt's cistjmary resting heart rate.
U.S. Patsnt Applifatlon Publicatijn 2003/0040774 bo Tgrry et al., chich is incorporated herein by referencx, describes a device foe treating patients xuffering fcom coggestive veart failure. The decice includes an lmplantable neurostimumator xor shimulating the patient's vagus nerve at or above the cardiac branch with ab elecvrycal pulse savegorm dt c stimujatiig rate sufficient to maintain the patient's heart beat at a rate well below the patient'x vormal restine heart rate, thereby allkwing rext and recovery of the heart muxcle, to increase in corokary blooe flos, and/og gcowth of coronary calillarnes. A netaboluc nced sensor detdctx bhe patienh's cnrrznt physical state and concomitanrly supppies a control smgnal to the keurosjimulatot to vary the stijulaflng rxte. If the deyection indicayes a state of
ricular arrhythmias, angina pectoris, and heart failure. conducted determine amplitudes, wave shapes and current achieve slowing of heart rate. The additionally studied an external device, triggered the R-wave of the electrocardiogram (ECG) of the subject to provide stimulation only an achievement of a certain heart rate. They found that when a pulsatile with frequency ten per second and 0.2 milliseconds pulse duration was applied to the vagus nerve, the heart rate be decreased to half the resting rate while preserving sinus rhythm. Low vagal stimulation was employed to induced and ectopic The further the use of implanted device in conjunction with the administration of Isuprel, a sympathomimetic drug. They found that Isuprel retained inotropic effect contractility, while chronotropic was by the vagal increased end diastolic volume brought about the heart rate by vagal tuning, coupled with contractility of heart induced by the inotropic effect Isuprel, appeared to increase the efficiency of cardiac (p. 79). U.S. Pat. No. 6,473,644 to Terry, Jr. et al., which is incorporated herein describes a method for patients suffering from failure increase output, stimulating or the vagus nerve with a sequence of substantially equally-spaced pulses by implanted neurostimulator. The frequency of the stimulating pulses is adjusted patient's rate reaches a rate within a relatively target range below the low the customary U.S. Application 2003/0040774 to Terry et which is incorporated herein by describes a device for heart failure. The device includes an implantable neurostimulator stimulating the patient's vagus nerve at or the cardiac branch with an electrical pulse waveform at a stimulating rate to maintain heart beat at a rate well below the normal resting heart rate, allowing rest and recovery of the heart muscle, to in blood flow, growth of coronary A metabolic need detects the patient's state and supplies control neurostimulator to vary the stimulating rate. the indicates a state of
ricular arrhythmias, angina pEctoris, and Heart FaiLurE. EXperImenTs were conducteD To deTermine amplitudes, frequEncieS, wAVe shAPeS and pUlse lenGThS OF thE sTiMulAtINg CurreNt tO achievE slowing of The HeArt rate. The auTHoRs additionAllY studied an exTerNal devIcE, trIGgereD by The R-wAve of tHE electRocardiogRaM (eCG) of tHE subjecT TO pRoviDe stimulation only UPoN An achievement oF a certAiN HeART raTe. THey found thAt When a PUlsatilE CuRRENt wITh a frequency oF ten pulses pER seCond anD 0.2 mIllISecondS pulsE dURatIon was appliEd to The vagus nErve, thE Heart raTE could bE decreAseD to Half THe ReStiNg RAte WHiLe sTIll PreserviNg SiNus rhYthm. lOW AMpliTudE vagAl stiMulation was emPloYed tO ConTrol iNduceD tacHyCardiAs and eCtopiC bEats. The authors fUrthEr studied The UsE of ThE implANted deVicE in ConjuncTion witH The AdMINIsTration of Isuprel, a sYmPAThOmimetic Drug. ThEY fOuND that IsuPrEl rEtaiNED its iNotrOPiC effect oF increASiNg ContracTiLity, whIlE itS chRonotROpic Effect Was contrOlled BY the vagal stimuLAtion: “An increaSEd END dIAstoLic Volume brougHt abOUt by SlowINg Of tHE hearT rate By VAgAL tuning, coupled with iNcReased ContrActility of the Heart inducED BY the inotRopiC EfFEct of Isuprel, apPeareD to increasE The efficIency Of cardiaC performaNCE” (p. 79).
U.S. Pat. NO. 6,473,644 to terRy, JR. et AL., WhIch is incorporATEd heReIn by refEreNce, descRibEs a MetHod FoR treating Patients SuFfErInG frOm heaRT failure To IncReAse CardiAC outpuT, by stImulAtInG Or mOdulatiNG tHE VaguS nErVe wiTh a SeQuencE of sUBstAntiallY equally-sPacED pulSeS bY an implAnted neurostiMuLator. The frEqUenCy of thE STimulatiNg pulses is adjusted until THe patieNt's Heart Rate Reaches a tArgEt rate WitHIn a relAtivelY stabLe TarGET rate RANgE beLoW the low end OF The PatieNt'S cusTomary rEsting heart rate.
U.S. PATenT Application PUblIcatION 2003/0040774 tO TeRRy ET al., WhICh iS INcorporated hereIn by refereNcE, DeScribes a deVIce FoR treatiNg patieNts suFFering fRom congesTive heart FaIlurE. tHe dEvice incluDes an impLantable nEUrostIMuLator For StimulAtIng The paTient's VAguS nervE at or aBoVe the cArdiaC bRanch witH an electrical pulse wavefOrm at a StimuLatIng rate suFfiCIenT to maintaIn thE patient's hEarT beAt at a RatE Well bElow THe PatIEnt's nOrmaL Resting heARt RatE, THeReby allowinG RESt aNd recOveRY of the HearT muscle, to increase IN coronary blood Flow, AND/or GroWTh of CoRonary capillarIes. a mETAbolic neEd Sensor detecTs the patIeNT's curRent phYsical State anD COnCOmitanTly sUppLies a contRol SiGNal to thE nEuROstimuLatoR tO vary tHe stimULatiNG Rate. If the detectiOn indICAtes a STatE of
ricular arrhythmias, angin a pectoris , and  he art  f ailu re.Experiments we r e co nducted to determine a mplit ud e s, f r eq uenci es, wav e  s h a pes  a nd  pu ls e  l ength s o f the s timulating  cu rr ent to achie v eslowing of  th e heart rate . T he aut ho rsa dditi ona lly s tudied an ext ernal dev ic e , trig g ered by t he  R-w ave of the electr o ca r diogram (ECG)of the  s u bj e c t t o p rovide sti mu latio n  only u p on a n  ac h ievement of a  certain he a rtrate.Th eyf ound t hat w he n  apulsatile c urre nt with a  frequ e ncy oft en puls es per  se con d an d  0 .2  mi ll i sec o nd s p u lse  duratio nwa s app lied t o thevag us n erve,  the heart ra tecoul d  be  decr eased  toha lf th e rest ing r at e while still p rese rving sin usrh yth m.  Lowa mplitu devag al stim ulation was  e m p l oy ed to control indu ce d ta chycardi as and ec to p ic beats .The  aut h o rs fu rthe r  s tudied t he use of  t he impl an ted de vi ceinconju n ctio n with  the adm inist r ation of Isupr e l, a sympatho m im e t ic drug . T hey found t hatI supr el r e ta ine d  itsinotr op i ce ffect of increasing  c ontrac tilit y, while itschronotrop i c effect w as c o nt r olled by the v agalstimulatio n : “An in creas ed end d iastolicv o lume bro ugh t a bou t b y sl owing of theh e artra te by v aga l tunin g,cou ple d w it h increas ed contr ac ti li ty  of  theh eart ind uc edby  th e ino t ropiceffec t of  I su p rel , appea r ed t o in cr ea se t heef ficie ncyo f c ardiacperforman ce” (p.79 ). 
U.S. P at. No. 6,473 ,6 44 to Terr y,  Jr . et a l . , whichis incorporated hereinb y refer enc e, de scri bes a met hod  for t rea t ing pa tients  suff er ing f rom h e a rt  fa il ure to inc r e ase  card ia c ou tput, b y stimulating or m o dul ating the vag usnerv e wi tha  s e que nc e  of s ubstantially eq ually-spac ed pu lses by an imp la nted ne urostim ulato r . The f requencyof the st im ulat i n g p ulses is a djusteduntil the patie n t' s hea rtrate r ea che s a t argetr ate  with in a r el ativel y sta bl e target  rate range below the l ow end  of t hepatient's  cu s tom ary resti ng h eart rate. 
U. S.Paten t A p plica tion Pu bli c ation  200 3 /0040774t oTer r y  e t al., whic h i s i ncorp ora t ed her einby reference, des c ribes a device  for t rea tin g  pat ie nts sufferingfro mc o ngestive  h eart failur e. The d ev i ce in cludes  an im plantab l e  n e urosti mula tor  for stim ula ti n g the p at ie n t's va gusne rve at  or ab o ve t h e  cardiac branchwitha n  elec t ric al pu ls e wavef o rm a t a stimul ating ratesuffic ient  to m aintain  t he pat ien t' s heart be a t at a ra te we ll belo wthepat ient's  nor m a l res ting  h ear t rate, t h e re b yal l owi ng r est a nd  rec overy oft he heart  mu s cle, to  i ncr e a se inc or o n ary bloodflo w, an d / or growtho f co r on a ry ca pillar ies. A  metabo l icne ed sens ord e tects the  patient' s  cu rr entphysical  s tate  a ndco ncomitantly sup plies acontrols i gnal t o t h e ne u rostim ul ator to vary  thest i mulatin g rat e. If t h e d ete cti on i ndi cate s  a state of
ricular arrhythmias,_angina pectoris,_and heart failure. Experiments_were conducted_to_determine amplitudes,_frequencies,_wave shapes and_pulse lengths of_the stimulating current to_achieve slowing of_the_heart rate. The authors additionally studied an external device, triggered by the R-wave of_the_electrocardiogram (ECG)_of_the_subject to provide stimulation only_upon an achievement of a_certain heart_rate. They found that when a pulsatile current_with_a frequency of_ten pulses per second and 0.2 milliseconds pulse duration_was applied to the vagus nerve,_the heart rate_could_be_decreased to half the_resting rate while still preserving sinus_rhythm. Low amplitude vagal stimulation was_employed to control induced tachycardias and ectopic_beats. The authors further studied the_use of the implanted device_in conjunction_with the administration of Isuprel,_a sympathomimetic drug._They found_that Isuprel retained_its inotropic effect of increasing contractility,_while its chronotropic_effect was controlled by the vagal_stimulation:_“An increased end_diastolic_volume_brought about_by slowing of_the_heart rate_by_vagal tuning, coupled with increased contractility_of_the heart induced by the inotropic effect_of Isuprel, appeared to_increase_the efficiency of cardiac_performance” (p. 79).
U.S. Pat. No._6,473,644 to Terry, Jr. et al.,_which is_incorporated herein_by reference, describes a method for treating patients suffering from heart_failure to increase cardiac output, by_stimulating or modulating the_vagus nerve_with_a sequence of_substantially_equally-spaced pulses_by an implanted neurostimulator. The frequency of_the stimulating_pulses is adjusted until the patient's_heart rate reaches a_target_rate within a relatively stable target_rate range below the low end_of the patient's customary resting_heart_rate.
U.S._Patent Application Publication 2003/0040774 to_Terry et al., which is incorporated_herein by reference,_describes a device for treating patients suffering_from_congestive heart failure. The device includes_an_implantable neurostimulator for stimulating the patient's_vagus_nerve_at or above the cardiac_branch with an electrical pulse waveform_at a stimulating rate sufficient to maintain the patient's_heart beat at_a rate well below the_patient's_normal_resting heart rate, thereby allowing rest and recovery of the_heart muscle,_to increase in_coronary blood flow, and/or growth of coronary capillaries. A metabolic_need sensor detects the patient's current physical_state and concomitantly supplies a control signal to the neurostimulator to_vary the stimulating rate. If the detection indicates_a state of