Techniques are provided for coordinating the delivery of cardioversion
therapy and overdrive pacing therapy to the heart of a patient, primarily
to prevent the re-occurrence of atrial fibrillation (AF) following a
cardioversion shock. Included are techniques for modulating the
aggressiveness of overdrive pacing by adjusting the magnitude of
overdrive pulses or by changing the electrodes with which overdrive
pacing pulses are generated. In one example, three phases or "tiers" of
AF suppression therapy are provided: cardioversion therapy; far-field
dynamic atrial overdrive (DAO) pacing; and near-field DAO pacing.
Briefly, a cardioversion shock is delivered to the heart of the patient
in response to the detection of AF, then smoothed, far-field overdrive
pacing pulses are delivered using widely-spaced electrodes for a period
of two minutes while the magnitude of the pulses is gradually reduced.
Finally, near-field overdrive pacing pulses are delivered more or les
continuously until another episode of AF is detected.