Impedance, e.g. 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. Other
methods vary the AA interval to maximize impedance change over the entire
cardiac cycle or during the atrial cycle.