Apparatus and methods for pacing the heart. The apparatus may include, and the methods may involve, an elongated member having: a delivery lumen that is configured to traverse the heart wall, the lumen having a proximal opening for receiving the instrument and a distal opening for deploying the instrument and an electrically conductive member that is configured to deliver to the heart wall a current that modifies a contraction frequency. The apparatus may include an access opening closure device that has: a distal end that is configured to be disposed interior the heart and contact endocardial tissue adjacent the access opening and a proximal end that is configured to be disposed exterior the heart and contact heart tissue adjacent the access opening and an electrode that is configured to discharge electrical energy into the heart wall to change the frequency. The apparatus may include an injectable needle pacing electrode.
