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Originally published September 22, 2026
Last updated September 22, 2026
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Atrial fibrillation (AFib) is the most common arrhythmia in the United States. Fully 5% of the population — just over 12 million people — experience the condition, and its prevalence rises with age, roughly doubling among those aged 70 to 79 and approaching 15% for patients 80 years and older.
And though advanced medical and interventional therapies have enabled the control and even cure of the disease at earlier stages, those outcomes still elude a subset of patients with particularly complex longstanding persistent AFib.
The barrier for these patients, however, isn’t an absence of treatment; it’s the treatment gap into which they often fall. Now, a new advanced multidisciplinary clinic for atrial fibrillation at Keck Medicine of USC – Pasadena, located at 590 S. Fair Oaks Ave., helps bridge that gap.
Ivan C. Ho, MD, is the director of cardiac electrophysiology for the USC Cardiac and Vascular Institute, part of Keck Medicine of USC, as well as the director of cardiac electrophysiology at the new multidisciplinary clinic in Pasadena. According to Ho, we’re living in a “golden age” of AFib treatment, as improvements to catheter ablation vastly expand the number of patients whom cardiac electrophysiologists can serve.
Nonetheless, Ho concedes, “I’m the first to acknowledge that there’s a segment of the AFib population that electrophysiologic techniques just cannot help.”
The reason, says Jonathan Praeger, MD, a cardiothoracic surgeon with the USC Cardiac and Vascular Institute and director of arrhythmia surgery at the new multidisciplinary clinic in Pasadena, is that a different pathology underlies these patients’ longstanding persistent AFib.
In patients with paroxysmal AFib, Praeger explains, arrhythmias originate around the myocardial muscle sleeves extending into the pulmonary veins within the left atrium—locations that endocardial techniques like cryoablation, radiofrequency (RF) ablation and pulsed field (PF) ablation can effectively identify and target.
But partly due to factors related to the architecture of the left atrium, in patients with longstanding persistent AFib, “the arrhythmia isn’t just around those pulmonary veins,” Praeger says. “We often see fibrosis and scarring with these patients that create the perfect setup for the self-sustaining electrical loops that maintain the AFib.”
As a result, data indicate that endocardial measures alone are less successful in getting and keeping such patients out of longstanding persistent AFib than is a hybrid approach that includes minimally invasive epicardial techniques, as well.
It’s this hybrid approach that the new advanced multidisciplinary clinic for atrial fibrillation at Keck Medicine of USC – Pasadena is unique in providing.
The clinic’s cardiac surgeons and electrophysiologists integrate their respective interventional expertise to offer both minimally invasive surgical treatments like convergent maze and totally thoracoscopic maze (TT-maze) — both combined with left atrial appendage (LAA) exclusion — as well as postsurgical electrophysiologic evaluation using the latest RF and PR technologies.
The clinic’s specialists also follow patient progress with long-term rhythm monitoring, risk-factor modification and management of comorbidities such as heart failure or valvular disease to further optimize outcomes.
“When patients visit the clinic,” Ho explains, “they meet with a cardiac electrophysiologist, a cardiac surgeon and a nurse practitioner all in one visit to discuss options. The goal is to fully evaluate each patient’s AFib risk factors, their treatment history — including treatment failures — and any cardiac abnormalities or other noncardiac comorbidities. Then we build the best treatment plan for them, whether that’s endocardial, surgical or both.”
Adds Praeger, “We take care of the patient as a team. It’s tailored, it’s collaborative and it offers patients procedures they can’t access everywhere, like TT-maze.”
Among those who could benefit from the clinic’s specialized services are patients with longstanding persistent AFib, a history of multiple unsuccessful catheter ablations, advanced heart failure or a need for concurrent cardiac procedures like CABG or valve repair, among other criteria.
As Ho puts it, “If someone’s already had 15 years of atrial fibrillation and two cardiac ablations and they’re still symptomatic, I want that patient to get the right care. They need to know that this clinic exists.”
Praeger agrees. “We gear everything toward doing what’s right for the patient,” he says. “Longstanding persistent AFib can really hinder patients’ lives. But when we get them out of AFib, they can live a normal life. It’s such a dramatic improvement. So, the more that people know about what we do, the fewer will fall through the gap.”
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