Patent ID: 8219195

Claim:
A method of automatic determination of a multi-chamber cardiac pacemaker's pacing parameter values providing optimal pacing therapy for a specific patient, comprising: receiving and storing an operator defined set of one or more programmable pacing parameters subject to variation, and operator defined parameter specific variation ranges and step widths of values for each pacing parameter, the pacing parameters being selected from the group consisting of atrioventricular delays (AV), inter-atrial delay (AA), inter-ventricular delay (VV), and heart rate (HR); defining a predetermined optimization cycle comprising a sequence of different, permutations of pacing parameter values based on the number of different pacing parameters selected and the operator defined variation range and step width for each pacing parameter; programming the different permutations of pacing parameter values one at a time to the pacemaker in accordance with the defined sequence of the optimization cycle; taking hemodynamic measurements of heart performance parameters of a patient for each programmed permutation of pacing parameter values through non-invasive thoracic or esophageal measurements; using the hemodynamic measurements to determine a stroke index (SI) of ventricular performance using the maximum rate of change of bioimpedance or bioadmittance, respectively; the stroke index (SI) in case of bioimpedance (Z) including at least one of the following terms:  ( ⅆ Z ⁡ ( t ) ⅆ t ) MIN  Z 0 , or  ( ⅆ Z ⁡ ( t ) ⅆ t ) MIN  the stroke index in the case of bioadmittance (Y) including at least one of the following terms: ( ⅆ Y ⁡ ( t ) ⅆ t ) MAX Y o , or ⁢ ⁢ ( ⅆ Y ⁡ ( t ) ⅆ t ) MAX , where ⁢ :  ( ⅆ Z ⁡ ( t ) ⅆ t ) MIN  is the maximum rate of change of impedance, ( ⅆ Y ⁡ ( t ) ⅆ t ) MAX is the maximum rate of change of admittance, Z 0 is the base impedance, and Y 0 is the base admittance; recording the stroke index determined for each permutation of applied pacing parameter values; and determining the optimal permutation of pacing parameter values for the patient from the stroke indices recorded for each permutation of pacing parameter values in the optimization cycle.