Conditions · Houston
Atrial fibrillation, treated as a plan — not a slogan
The upper chambers quiver instead of squeezing. That raises stroke risk and often drains energy. Care here answers three questions in the first visit: stroke, rate or rhythm, and whether ablation belongs on the table.
Reviewed by David L. Boone Jr., MD ·
What AFib is doing to the heart
Instead of a coordinated squeeze, the atria fibrillate. Blood can stagnate. The ventricle may race, pause, or both. People feel it as fatigue, breathlessness, fog, skipped beats — or feel nothing and learn it from a watch, a preoperative ECG, or a stroke workup.
Pattern matters. Paroxysmal AFib starts and stops. Persistent AFib stays until something interrupts it. Long-standing persistent disease has lived in the atrium long enough that isolation of the veins is only part of the story. The label on the chart is less important than a tracing captured during symptoms and a clear stroke-risk score.
Why Houston patients end up on the wrong page
Search results for “AFib specialist Houston” are hospital directories, device manufacturers, and EP sites that lead with a product name. Useful pages do the unglamorous work: name the rhythm, separate stroke prevention from symptom control, and say when ablation helps versus when it does not.
Precision Cardiology is a physician-owned electrophysiology practice. Dr. David Boone is board-certified in cardiovascular disease and clinical cardiac electrophysiology. He evaluates you, performs the procedure if there is one, and keeps the follow-up. That structure is the product.
The three questions the first visit is built around
1. Stroke risk. Anticoagulation is a separate decision from whether the heart is in sinus rhythm. CHA2DS2-VASc is a starting framework, not a slogan. If a left-atrial appendage device is ever relevant, that is a later conversation — after the score and the bleeding risk are honest.
2. Rate or rhythm. Some people do well with a quieter ventricle and no chase for sinus rhythm. Some do not: they stay tired, the ventricle is hard to control, or they are young enough that decades of AFib is a poor plan. Rhythm control can be a medication, a cardioversion, an ablation, or a sequence of those.
3. Is ablation on the table? Only after 1 and 2. If the job is pulmonary-vein isolation, pulsed field ablation is often the energy we discuss. Other circuits may need a different energy or no ablation; that is decided on the map, not as a default. If the tracing is flutter, SVT, or PVCs wearing an AFib label, we treat the actual circuit.
How we capture the rhythm
An office ECG is a snapshot. A Holter records 24–48 hours. A patch or event monitor records days to weeks. An implantable loop recorder watches for months when events are rare — fainting, fleeting palpitations, a watch alert you cannot reproduce. Echo, thyroid labs, and a sleep-apnea history belong in the same pile because they change the plan.
Treatment, in the order it should be discussed
- Stroke prevention — anticoagulation when indicated; lifestyle and blood-pressure work that actually happens.
- Rate control — beta blockers, calcium-channel blockers, occasionally digoxin; AV-node ablation plus a pacemaker only when that is the honest remaining option.
- Rhythm control without a catheter — cardioversion, antiarrhythmic drugs chosen for the ventricle you have, not the one in a textbook.
- Catheter ablation — pulsed field ablation when pulmonary-vein isolation is the job and the anatomy fits; a different plan when it is not. Mapped in a hospital EP lab. Dr. Boone does the case.
- The rest of the patient — sleep apnea, alcohol, weight, thyroid, exercise. Ignoring those is how “successful” ablations look unsuccessful at 90 days.
Where you are seen
Clinic hours Monday–Friday, 8am–5pm. One number: (832) 972-7300.
- Texas Medical Center — 6560 Fannin Street, Suite 1840, Houston, TX 77030. Best if you already see TMC specialists.
- Clear Lake / Webster — 450 W Medical Blvd, Suite 510, Webster, TX 77598. League City, Friendswood, NASA / Bay Area.
- Pearland — 12234 Shadow Creek Parkway, Suite 6106, Pearland, TX 77584. South and southeast Houston.
Procedures are performed at Houston Methodist, Memorial Hermann, Baylor St. Luke’s, and HCA hospitals across those same corridors.
When to come in sooner
New neurologic symptoms, fainting, chest pain, or severe shortness of breath are emergency-department problems — call 911. A new diagnosis, a watch alert you cannot ignore, medicines that made you miserable, or a cardiologist who mentioned ablation are clinic problems. Those can usually be seen this week.
Questions
Do I need a referral?
No. Call the office or send a request. If another physician is sending records, fax (855) 538-7649. We typically contact the patient within one business day and send a consult note back.
What happens at the first visit?
History, exam, review of prior tracings, and a plan built on three questions: stroke risk, rate or rhythm, and whether ablation belongs on the table. You should leave knowing the suspected rhythm and the next concrete step. Patient guide.
What should I bring?
Photo ID, insurance card, medication list, and any ECGs, Holter or event reports, echocardiograms, or discharge papers. A disc or portal printout is fine.
Why an electrophysiologist rather than my cardiologist?
Your cardiologist may manage uncomplicated AFib well. Come here when the diagnosis is still loose, ablation is being considered, antiarrhythmic choice is not straightforward, or a device may be part of the plan.
Does restoring sinus rhythm stop anticoagulation?
No. Restoring sinus rhythm — with medication, cardioversion, or ablation — does not automatically mean a blood thinner can stop. Stroke risk is separate: it follows your risk profile, such as age, blood pressure, diabetes, prior stroke, and vascular disease, not the energy used in the lab.
Is PFA automatic?
No. PFA is used when isolation of the veins is the job and the anatomy fits. Many flutters, SVTs, and selected AFib cases need a different energy or no ablation. That decision is made on the map, not as a default. Read how we use PFA.
Is a watch strip a diagnosis?
A watch strip is a clue. It is not a full diagnosis. Save the tracing, note when it happened and how long it lasted, and bring it to the visit. The tracing is what names the rhythm, and a monitor matched to how often your symptoms happen is how it gets caught.
Related: All conditions · Treatments · Patient guide · Dr. Boone
Leave the first visit with a next step.
Not a brochure. A suspected rhythm, a stroke plan, and whether ablation is on or off the table.