Cardiac Electrophysiology
Comprehensive evaluation, treatment, and long-term management of atrial fibrillation using the most advanced therapies available.
Atrial fibrillation (AFib) is the most common sustained cardiac arrhythmia, affecting more than 6 million Americans. It occurs when the heart's two upper chambers (the atria) beat chaotically and out of sync with the lower chambers (the ventricles), producing an irregular and often rapid heart rhythm.
In a normal heart, electrical signals originate from the sinoatrial (SA) node and travel in an organized pattern to coordinate each heartbeat. In AFib, disorganized electrical impulses — often originating from the pulmonary veins — fire rapidly and irregularly, causing the atria to quiver rather than contract effectively.
Common symptoms include palpitations, shortness of breath, fatigue, lightheadedness, and reduced exercise tolerance. However, some patients experience no symptoms at all, making routine screening important. Left untreated, AFib significantly increases the risk of stroke, heart failure, and other cardiovascular complications.
Treatment of AFib is individualized based on the type of AFib, symptom burden, stroke risk, and overall cardiac health. Dr. Kim employs a comprehensive, evidence-based approach that may include one or more of the following strategies.
Rate control medications (such as beta-blockers or calcium channel blockers) slow the ventricular response to AFib, reducing symptoms and protecting the heart from the effects of a rapid heart rate. This strategy is appropriate for patients with permanent AFib or those who are asymptomatic at controlled rates.
Rhythm control aims to restore and maintain normal sinus rhythm. This may be achieved through antiarrhythmic medications or cardioversion (an electrical shock delivered under sedation to reset the heart's rhythm). Rhythm control is particularly beneficial in symptomatic patients and those with early-stage AFib, and has been shown in recent trials to reduce cardiovascular events when initiated early.
AFib increases stroke risk up to five-fold by allowing blood to pool and clot in the left atrial appendage. Anticoagulation therapy — using direct oral anticoagulants (DOACs) or warfarin — is a cornerstone of AFib management for patients with elevated stroke risk, as determined by the CHA₂DS₂-VASc scoring system. Dr. Kim carefully evaluates each patient's stroke and bleeding risk to determine the most appropriate anticoagulation strategy.
Catheter ablation is a minimally invasive procedure in which thin, flexible catheters are guided through the veins to the heart. Energy is delivered to electrically isolate the pulmonary veins — the most common source of AFib triggers — from the rest of the atrium. This procedure, known as pulmonary vein isolation (PVI), is the most effective long-term strategy for maintaining sinus rhythm in symptomatic AFib patients.
Catheter ablation is recommended for patients who remain symptomatic despite antiarrhythmic medications, those who prefer a non-pharmacologic approach, and increasingly as a first-line option in early-stage AFib. Multiple clinical trials have demonstrated that ablation is superior to medications alone for rhythm control and quality of life.
Dr. Kim utilizes pulsed field ablation (PFA), the most advanced energy modality currently available for AFib catheter ablation. Unlike traditional thermal ablation techniques (radiofrequency or cryoablation), PFA uses precisely controlled electrical fields to selectively eliminate cardiac tissue responsible for AFib while sparing surrounding structures such as the esophagus, phrenic nerve, and pulmonary veins.
PFA offers several important advantages over conventional ablation:
PFA energy preferentially affects cardiac muscle cells, minimizing collateral damage to adjacent non-cardiac structures.
PFA can achieve pulmonary vein isolation more rapidly than conventional techniques, reducing overall procedure duration.
Clinical data demonstrate a low rate of serious complications, including a significantly reduced risk of esophageal injury compared to radiofrequency ablation.
Early clinical evidence supports durable pulmonary vein isolation with PFA, with outcomes comparable or superior to established ablation methods.
The long-term goal of AFib management is to reduce symptoms, prevent stroke, preserve heart function, and improve quality of life. Outcomes depend on the type and duration of AFib, the presence of underlying heart disease, and the treatment strategy employed.
For catheter ablation, success rates vary by AFib type. In paroxysmal AFib, a single ablation procedure achieves freedom from AFib in approximately 70–80% of patients at one year; repeat procedures further improve long-term success rates. In persistent AFib, outcomes are somewhat lower but remain significantly better than antiarrhythmic drug therapy alone.
Importantly, the EAST-AFNET 4 trial demonstrated that early rhythm control — including ablation — reduces the composite risk of cardiovascular death, stroke, and hospitalization for heart failure or acute coronary syndrome. This has shifted the paradigm toward earlier, more aggressive rhythm control in appropriate patients.
Long-term follow-up after ablation includes cardiac monitoring to detect recurrent AFib, ongoing assessment of stroke risk, and management of any underlying cardiovascular risk factors. Dr. Kim provides comprehensive, individualized follow-up care to optimize outcomes for each patient.
Important note: AFib management is highly individualized. The information on this page is for educational purposes only and does not constitute medical advice. Please schedule a consultation with Dr. Kim to discuss your specific diagnosis and treatment options.
If you have been diagnosed with AFib or are experiencing symptoms of an irregular heartbeat, contact our office to schedule an evaluation with Dr. Kim.
(949) 785-6300