for cardiac rhythm management , a combination of cardiac pacing and a noninvasive heart monitoring is proposed for the determination of a set of programmable pacing parameters hemodynamically beneficial to the patient . the apparatus incorporates a cardiac pacemaker and a thoracic electrical bioimpedance heart monitor . this combination allows the creation of a closed - loop system that obtains pacing parameter settings providing hemodynamically beneficial pacing therapy to the patient as determined by measuring and recording of stroke volume , cardiac output , and other indices of ventricular performance by the heart monitor during an optimization cycle automatically employing different permutations of values of pacing parameters such as atrioventricular delays , inter - atrial delay , inter - ventricular delay , or heart rate , that are sequentially programmed to the pacemaker . the hemodynamically beneficial permutation of pacing parameter values is determined from all recordings and programmed to the pacemaker for permanent or temporary pacing therapy .