A cardiac rhythm management device includes a dual chamber pacemaker,
especially designed for treating congestive heart failure. The device
incorporates a program microcontroller which is operative to adjust the
pacing site, AV delay and interventricular delay of the pacemaker so as to
achieve optimum hemodynamic performance. Atrial cycle lengths measured
during transient (immediate) time intervals following a change in the
site, AV delay and interventricular delay are signal processed and a
determination can then be made as to which particular configuration yields
the optimum performance. Paced transient beats following periods of
baseline beats are synchronized to the patient's respiratory cycle to
minimize effects of respiratory noise on atrial cycle length measurements.
