Atrial fibrillation is the most common sustained heart rhythm disorder and a leading cause of stroke. Specialized care from a cardiac electrophysiologist meaningfully changes outcomes, medication choice, ablation timing, and stroke prevention all benefit from EP-specific expertise.
A new procedure center at the Texas Medical Center
The Advanced Cardiovascular Institute at the Texas Medical Center, at 6624 Fannin St, Houston, TX 77030, opens in June 2026, our new ambulatory surgery center for cardiac electrophysiology. It will perform catheter ablation, pacemaker, ICD, and loop recorder procedures in the Texas Medical Center for the comfort and convenience of our patients.
Consultations and follow-up continue at our Hargrave Rd clinic in Northwest Houston, with procedures performed at the most appropriate location: Houston Methodist Willowbrook, Houston Methodist Cypress, Baylor St. Luke’s Medical Center, St. Luke’s The Vintage, Memorial Hermann Memorial City, or the new TMC ASC. Learn more → or call (832) 478-5067 to schedule.
What atrial fibrillation is
Atrial fibrillation (AFib, AF) is an irregular rhythm that originates in the upper chambers of the heart (the atria). Instead of contracting in a coordinated way, the atria fire chaotically, producing an irregular and often rapid ventricular rate.
Three patterns are recognized:
Paroxysmal AFib: episodes that start and stop on their own, usually lasting less than seven days. Often the earliest stage of disease.
Persistent AFib: episodes that don't self-terminate and require cardioversion or other intervention to restore normal rhythm.
Long-standing persistent / permanent AFib: chronic AFib where rate-control is the primary strategy.
The earlier AFib is identified and treated, the better the long-term outcome. There is growing evidence that early rhythm control, particularly with ablation in selected patients, reduces long-term cardiovascular events.
Recognizing AFib: symptoms to know
AFib symptoms vary widely. Some patients describe an unmistakable "fluttering" or "racing" feeling in the chest. Others feel fatigue, shortness of breath, decreased exercise tolerance, or simply a sense that something is off. A meaningful number of patients have no symptoms at all and discover AFib only on a routine ECG or wearable recording.
Symptoms that should prompt evaluation:
Sustained irregular heartbeat lasting minutes to hours
Sudden onset rapid heart rate with dizziness or chest discomfort
Unexplained shortness of breath, particularly on exertion
New fatigue out of proportion to activity
Wearable or home ECG that flags an irregular rhythm
The gold standard is a recording. A 12-lead ECG taken during an episode is diagnostic. For paroxysmal patients whose episodes are brief or infrequent, an ambulatory monitor is the next step:
Holter monitor: 24-48 hours of continuous recording
Patch monitor: 14-30 days of continuous recording (the modern standard for episodic palpitations)
Mobile cardiac telemetry: real-time transmission with auto-alerts
Implantable loop recorder: long-term (up to 3 years) for very infrequent episodes or cryptogenic stroke evaluation
The diagnostic workup also includes an echocardiogram to assess heart structure, a thyroid panel (hyperthyroidism is a treatable AFib trigger), and screening for sleep apnea, one of the most underdiagnosed and most modifiable AFib triggers.
Treatment options: what we offer
AFib treatment has three goals: prevent stroke, control symptoms, and restore normal rhythm when appropriate.
Stroke prevention
Risk-stratified using CHA2DS2-VASc score. Most patients above a threshold benefit from a direct oral anticoagulant (apixaban, rivaroxaban, dabigatran, edoxaban) or warfarin. Patients who can't tolerate long-term anticoagulation may be candidates for WATCHMAN left atrial appendage closure.
Rate control
Beta-blockers, calcium channel blockers, and (in selected cases) digoxin. The goal is a controlled ventricular rate that doesn't cause symptoms. Many older patients with permanent AFib are managed primarily with rate control.
Rhythm control: medications
Antiarrhythmic medications (flecainide, propafenone, sotalol, dronedarone, dofetilide, amiodarone) reduce AFib burden. Each has specific indications and side-effect profiles. We tailor the choice to your underlying heart structure, kidney function, and other medications.
Rhythm control: ablation
Catheter ablation is increasingly the preferred rhythm-control strategy for symptomatic patients, particularly those with paroxysmal AFib, younger patients, and those who tolerate antiarrhythmics poorly. Modern energy sources include pulsed-field (PFA), radiofrequency (RF), and cryoballoon.
Lifestyle
Weight loss, sleep apnea treatment, alcohol moderation, blood pressure control, and exercise meaningfully reduce AFib burden in many patients, sometimes enough to defer or avoid further intervention.
Why see an electrophysiologist for AFib
A general cardiologist can manage uncomplicated AFib well. An electrophysiologist becomes important when:
Ablation is being considered (most general cardiologists don't perform AFib ablation)
Antiarrhythmic medications need careful selection and monitoring
WATCHMAN or other LAA closure is on the table
The diagnosis is unclear or atypical (atrial flutter, focal atrial tachycardia, AVNRT mimicking AFib)
The patient has structural heart disease, heart failure, or an unusual presentation
The earlier in the disease course the EP is involved, the more treatment options are available, particularly for ablation, where success rates are higher in paroxysmal disease than in long-standing persistent.
Frequently asked questions
What kind of doctor treats atrial fibrillation?
Atrial fibrillation is treated by cardiologists and, for advanced or procedural management, by cardiac electrophysiologists (EPs). General cardiologists can manage uncomplicated AFib well; an EP becomes essential when ablation, advanced antiarrhythmics, WATCHMAN, or complex disease is involved.
Do I need an electrophysiologist or just a cardiologist for AFib?
If your AFib is well-controlled on medications and you're not considering ablation or LAA closure, a general cardiologist is reasonable. An EP is recommended when ablation is being considered, when antiarrhythmics are being chosen or monitored, when WATCHMAN is on the table, when the diagnosis is atypical, or when AFib coexists with structural heart disease.
How is atrial fibrillation diagnosed?
AFib is diagnosed with an electrocardiogram (ECG) showing the characteristic irregular rhythm without P waves. For patients with intermittent symptoms, ambulatory monitoring is used, Holter (1-2 days), patch (14-30 days), mobile cardiac telemetry, or an implantable loop recorder for infrequent episodes. The workup also includes echocardiogram and thyroid testing.
Can atrial fibrillation be cured?
AFib cannot always be cured outright, but catheter ablation can produce long-term freedom from AFib in many patients, particularly those with paroxysmal AFib treated early in the disease course. Persistent and long-standing persistent AFib are harder to treat curatively and often require lifestyle changes and ongoing medical therapy alongside any procedure.
Is AFib ablation safe?
Modern AFib ablation is performed routinely and has a strong safety record. Serious complications occur in 1-3% of cases at experienced centers. Pulsed-field ablation has further reduced certain rare complications (esophageal injury, phrenic nerve injury) compared to traditional thermal energy. Discuss your specific risk profile with the EP performing the procedure.
