Evaluation of the Safety and Effectiveness of the OPTIMIZER System in Subjects With Heart Failure: FIX-HF-5

IMPULSE Dynamics' FIX HF 5 US Study is a prospective, multi-center, study to evaluate the
safety and efficacy of cardiac contractility modulation (CCM) signals delivered by the
implantable OPTIMIZER™ System in patients with NYHA class III/IV heart failure. The study
will involve the recruitment of approximately 420 subjects at a total of up to 50 sites
nationwide.

Those subjects who fulfill all inclusion and exclusion criteria based upon baseline test
results will be randomized to receive the OPTIMIZER™ System or to a control group. All
subjects randomized will be followed for 1 year and shall receive the same study related
assessments throughout the course of the study. In addition, all subjects will continue to
receive optimal medical therapy for the treatment of their heart failure.

The primary efficacy assessment consists of a change in exercise tolerance measured by
cardiopulmonary exercise testing at baseline and 6 months. Safety variables, such as the rate
and cause of hospitalizations or death, shall be collected in both groups and shall be
compared at 12 months.

Inclusion Criteria:

- Subjects who are 18 years of age or older

- Subjects who are either male or female

- Subjects who have a baseline ejection fraction of 35% or less by echocardiography.

- Subjects who have been treated for heart failure for at least 90 days (including
treatment with a β-blocker for at least 90 days unless the patient is intolerant) and
are in New York Heart Association functional Class III or IV at the time of
enrollment.

- Subjects receiving appropriate, stable medical therapy during the 30 days prior to
enrollment for treatment of heart failure, consisting of the appropriate doses of
diuretics, ACE-inhibitor or angiotensin II receptor blocker and β-blocker. Stable is
defined as no more than a 100% increase or 50% decrease in dose.

- Subjects who, in the opinion of the Principle Investigator (based on the current
guidelines for clinical practice), have a clinical indication for an implanted cardiac
defibrillator (ICD) and/or pacemaker, must have an existing device or agree to undergo
implantation of such a device unless the patient refuses to undergo the implantation
of such device for personal reasons.

- Subjects who are willing and able to return for all follow-up visits.

Exclusion Criteria:

- Subjects whose baseline VO2,max is <9 ml 02/min/kg.

- Subjects who have a potentially correctible cause of heart failure, such as valvular
heart disease or congenital heart disease.

- Subjects who have clinically significant angina pectoris, consisting of angina during
daily life (i.e., Canadian Cardiovascular Society Angina score of II or more), an
episode of unstable angina within 30 days of enrollment, or angina and/or
electrocardiography (ECG) changes during exercise testing performed during baseline
evaluation.

- Subjects who have been hospitalized for heart failure which required the use of
inotropic support within 30 days of enrollment.

- Subjects who have a clinically significant amount of ambient ectopy, defined as more
than 8,900 premature ventricular complexes (PVCs) per 24 hours on baseline Holter
monitoring.

- Subjects who have chronic atrial fibrillation or chronic atrial flutter or those
cardioverted within 30 days of enrollment.

- Subjects whose exercise tolerance is limited by a condition other than heart failure
(e.g., angina, chronic obstructive pulmonary disease [COPD], peripheral vascular
disease, orthopedic or rheumatologic conditions) or who are unable to participate in a
6-minute walk or a cardiopulmonary stress test.

- Subjects who are scheduled for a coronary artery bypass graft (CABG) or a percutaneous
transluminal coronary angioplasty (PTCA) procedure, or who have undergone a CABG
procedure within 90 days or a PTCA procedure within 30 days of enrollment.

- Subjects who have a biventricular pacing system or who have an accepted indication for
such a device.

- Subjects who have had a myocardial infarction within 90 days of enrollment.

- Subjects who have mechanical tricuspid or aortic valves.

- Subjects who have a prior heart transplant.

- Subjects who are participating in another experimental protocol.

- Subjects who are unable to provide informed consent.