Pacemaker Optimization Mechanisms in the Spectrum of Cardiac Disease Rationale to Protocol

Introduction: The problem can be stated as over three billion choices to improve 14 disease states with nine optimization goals (some of the optimization goals are diametrically opposed) to improve dyspnea, shortness of breath, fatigability, exercise intolerance, edema, swelling, fluid retention, and arrhythmias. The goal is to increase the Left Ventricular Outflow Integral, reduce mitral regurgitation, increase longitudinal conduction velocities, and restore synchrony of the septum to the ventricle that needs it the most. The paper is organized in the following sections: (I) Spectrum of Cardiac Disease and Desired Pacing Outcomes; (II) Echo Evaluation of Disease Processes; (III) Pacing Goals in the Spectrum of Disease; (IV) Remodeling—Mathematical Model; (V) Method of Optimization of the Pacing Devices. Conclusions: Pacing trials provided the basic justification for an additional pacing lead but fell short in optimizing individual patients. The physician needs to recognize the spectrum of disease and use the protocol to improve the quality of life of the individual patient. A method to accomplish this task for the spectrum of cardiac disease is presented.