Abstract: Objective To evaluate the instructive role of echocardiography in atrioventricular optimization compared with experienced optimization. Methods Sixty-six patients who were implanted with dual chamber pacemaker in our hospital from May 2014 to December 2014 were enrolled in this study and they were randomly divided into two groups. One week after operation, atrioventricular interval was programmed with experience in group A. At the same time, we used echocardiography to optimize the atrioventricular interval in group B. The first follow-up began at 3 months after implantation, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), aortic valve velocity time integral (VTI), pro-brain natriuretic peptide (Pro-BNP), 6-minute walk distance test (6MWT), New York Heart Association functional class (NYHA) were evaluated and then programmable methods of the atrioventricular interval were exchanged. Another 3 months later, the second follow-up came. The cardiac function was tested again. Then we evaluated the differences between the two methods. Results No difference was found in the proportion of ventricular pacing. In group A, the cardiac function index at 6 months was better than that at 3 months with significant differences LVEF (56.2±3.3)% vs (60.7±4.3)%, P=0.038; VTI (22.6±4.5) cm vs (25.1±4.6) cm, P=0.027; 6MWT (327.4±128.6) m vs (396.5±115.1) m, P=0.015; Pro-BNP (298.6±198.6) pg/ml vs (118.3±156.4) pg/ml, P=0.028. In group B, the cardiac function index at 3 months was preferable to that at 6 months with significant differences LVEF (59.2±5.6)% vs (58.2±4.2)%, P=0.024; VTI (25.2±4.9) cm vs (23.1±3.9) cm, P=0.014; 6MWT (379.8±108.7) m vs (364.8±113.7) m, P=0.039; Pro-BNP (187.5±157.6) pg/ ml vs (243.4±186.9) pg/ml, P=0.014. NYHA and LVEDD were not changed obviously in two groups. Conclusion Atrioventricular optimization with echocardiography helps maintain heart function. Furthermore, echocardiography can be an effective instructive method to optimize the atrioventricular interval of dual pacemaker.