Patent ID: 8131363

Claim:
A cardiac rhythm management device, comprising: pulse generation circuitry for delivering electrical stimulation to a myocardial site via a pacing channel; sensing circuitry for sensing cardiac activity via a sensing channel; one or more sensors for measuring a physiological variable related to myocardial contractility; a controller programmed to deliver conventional pacing or high-output pacing (HOP) stimulation via the pacing channel; wherein the controller is further programmed to deliver the HOP stimulation in a HOP mode as specified by a set of one or more HOP stimulation parameters; wherein the set of one or more HOP stimulation parameters includes a parameter that specifies that the HOP stimulation, in a first HOP mode, is a stimulation pulse delivered during a refractory period following a conventional pacing pulse or, in a second HOP mode, is a pacing pulse with energy higher than a conventional pacing pulse delivered in accordance with a bradycardia pacing mode; and, wherein the controller is further programmed to optimize the HOP stimulation by delivering the HOP using different parameter sets, evaluate the hemodynamic response thereto as reflected by the one or more measured physiological variables, and select the parameter set with the best hemodynamic response for delivering HOP.