Abstract: In an implantable medical device disclosed herein, a real-time left atrial pressure (“LAP”) signal obtained from a patient's heart is used as a feedback control mechanism to adjust one or more device parameters. In accordance with one example embodiment of the invention, the device identifies specific characteristics and attributes of the LAP signal that correlate to hemodynamic performance, and adjusts the device parameters to optimize the LAP characteristics and attributes. The example device is a dual-chamber pacing system, the controlled operating parameter may include the atrioventricular pacing delay, and one LAP attribute suitable for controlling the atrioventricular pacing delay relates to time intervals of v-wave, a-wave, and/or c-wave characteristics of the LAP signal.