Selection of pacing sites to enhance cardiac performance

A method, implementable by a cardiac therapy system having a plurality of electrodes disposed at multiple electrode locations in or on a left ventricle of the heart, the method being suitable for delivering cardiac resynchronization therapy to the heart, comprising:

• delivering a cardiac resynchronization pacing therapy (CRT) using the cardiac therapy system which is configured to select electrodes of the plurality of electrodes for the CRT using a first selection process in response to detecting an acute change in a hemodynamic state of a patient and to select electrodes of the plurality of electrodes for the CRT using a second selection process in response to detecting a chronic change in the hemodynamic state of the patient, the second selection process being different from the first selection process;
• pacing the heart to deliver the CRT using a first one or more electrodes of the plurality of electrodes;
• monitoring for both the chronic change and the acute change in the hemodynamic state of the patient;
• determining a distribution of an electrical, mechanical, or electromechanical parameter related to contractile function of the left ventricle, wherein determining the distribution involves measuring, for two or more of the multiple electrode locations, a value of the electrical, mechanical, or electromechanical parameter;
• in response to detecting the acute change, selecting a second one or more electrodes of the plurality of electrodes based on the parameter distribution using the first selection process;
• in response to detecting the chronic change, selecting a second one or more electrodes of the plurality of electrodes based on the parameter distribution using the second selection process;
• and
• pacing the heart to deliver the CRT using the selected second one or more electrodes.