Methods and devices for determining optimal Atrial to Ventricular (AV) pacing intervals and Ventricular to Ventricular (VV)
delay intervals in order to optimize
cardiac output. Impedance, preferably sub-threshold impedance, is measured across the heart at selected
cardiac cycle times as a measure of chamber expansion or contraction. One embodiment measures impedance over a long
AV interval to obtain the minimum impedance, indicative of maximum ventricular expansion, in order to set the
AV interval. Another embodiment measures impedance change over a cycle and varies the AV pace interval in a binary search to converge on the
AV interval causing maximum impedance change indicative of maximum ventricular output. Another method varies the right
ventricle to left
ventricle (VV) interval to converge on an impedance maximum indicative of minimum cardiac volume at
end systole. Another embodiment varies the VV interval to maximize impedance change.