Expert Voices: HCA Healthcare physician shares how pulsed field ablation is transforming atrial fibrillation care

Physicians have always been at the heart of HCA Healthcare — two of our three founders were physicians. Today, that legacy continues through a network of more than 44,000 active and affiliated physicians whose clinical expertise shapes how care is delivered across our system. Through our blog series, HCA Healthcare Expert Voices, we spotlight exemplary physicians who are advancing the practice of medicine — bringing deep clinical insight, leading-edge research and innovative care strategies to some of the most complex and critical patient needs.

Key takeaways:

• AFib is the most common heart rhythm abnormality and significantly increases the risk of stroke, heart failure and dementia.
• Pulsed field ablation is making AFib treatment faster, safer and more effective for many patients.
• Recognizing symptoms such as fatigue, shortness of breath or an irregular heartbeat — or responding to an AFib alert from a smartwatch — can help people seek evaluation and treatment sooner.
• In conjunction with the HCA Healthcare Research Institute, HCA Healthcare physicians are advancing AFib care through clinical research and innovation, helping refine pulsed field ablation and improve patient outcomes.

John Day, MD, Cardiac Electrophysiologist
St. Mark’s Hospital (Salt Lake City, Utah)
HCA Healthcare Physician Director for Electrophysiology

Atrial fibrillation (AFib) is the most common heart rhythm disorder, affecting millions of Americans and significantly increasing the risk of stroke, heart failure and dementia. Advancements in catheter ablation are creating new possibilities for people living with the condition — including pulsed field ablation, a technology that uses targeted electrical energy to treat the heart issue responsible for abnormal heart rhythms.

As one of the largest providers of cardiac ablation and electrophysiology care in the U.S., HCA Healthcare has extensive experience treating patients with heart rhythm disorders. At HCA Healthcare’s St. Mark’s Hospital in Salt Lake City, Utah, Dr. John Day is helping shape this new era of AFib treatment. A cardiac electrophysiologist, cardiovascular physician lead for HCA Healthcare’s Mountain Division and former president of the Heart Rhythm Society, Dr. Day has spent more than 25 years treating heart rhythm disorders and has been involved in researching pulsed field ablation since before the technology received U.S. Food and Drug Administration (FDA) approval.

“From my earliest memory, I knew I wanted to be a cardiologist,” said Dr. Day. During his fellowship at Stanford University, he found himself drawn to cardiac electrophysiology after his first rotation and saw treating heart rhythm disorders as an area where he could make the greatest impact.

Following the FDA’s approval of pulsed field ablation in 2024, St. Mark’s Hospital became the first center in Utah to offer the technology, with Dr. Day becoming the first physician in Utah to perform the procedure.

Dr. Day’s work in this space also extends beyond the electrophysiology lab. In conjunction with the HCA Healthcare Research Institute, he and other HCA Healthcare electrophysiologists continue to study pulsed field ablation and explore opportunities to refine its use and improve patient outcomes.

His research involvement in pulsed field ablation predates its approval. Dr. Day served as a review referee for the ADVENT clinical trial, a landmark study published in The New England Journal of Medicine in 2023. Three of the trial’s 20 authors were affiliated with HCA Healthcare, reflecting the depth of electrophysiology expertise across the organization.

Over the course of his career, Dr. Day has seen atrial fibrillation care evolve from implanting pacemakers and defibrillators to performing catheter ablations, helping patients reduce the symptoms and long-term risks associated with AFib. Along the way, he has witnessed advancements in AFib treatment, but he says one innovation stands above the rest.

“Nothing has had a bigger impact on the lives of our AFib patients than pulsed field ablation,” he says. “The procedures are much faster, safer and far more effective.”

That impact is becoming increasingly important as AFib grows more common. Dr. Day notes that an estimated one in four Americans will experience at least one episode of atrial fibrillation at some point during their life. AFib Awareness Month, observed each September, offers an opportunity not only to recognize signs and risks of the condition, but also to understand how advancements in treatments and clinical research are changing the way AFib is managed.

What is atrial fibrillation (AFib)?

Dr. Day: Atrial fibrillation is the most common heart rhythm abnormality, or arrhythmia. Normally, the upper and lower chambers of your heart work together in a steady, coordinated rhythm. With atrial fibrillation, the upper chambers of the heart — the atria — beat in a rapid, disorganized way. They’re essentially quivering.

That causes the heart to beat irregularly and can prevent blood from moving through the atria as efficiently as it should. When blood pools in the heart, it can form clots. If a clot forms in the heart, it can potentially be pumped to the brain, where it can block blood flow and cause a stroke.

Atrial fibrillation can look different from one person to another. Some of my patients experience occasional episodes, while others develop more persistent forms of the condition. That’s one reason identifying atrial fibrillation and working with your doctor to determine the right treatment approach is so important.

What are some of the symptoms of AFib, and why should they be taken seriously?

Dr. Day: While many people assume they’d feel their heart beating fast or chaotically, atrial fibrillation symptoms are often more subtle — and some people may not notice symptoms at all.

The most common symptom we see in patients is fatigue. The second most common is getting winded very easily with minimal exertion. Some people also experience palpitations, chest discomfort, shortness of breath, dizziness or rapid or irregular heartbeat.

These symptoms are important to pay attention to because atrial fibrillation isn’t just a heart rhythm issue. Over time, it can increase the risk of serious complications, including stroke and heart failure, and our research has also linked it to an increased cognitive decline and dementia. Even if the symptoms are mild, it’s worth getting evaluated rather than assuming they are simply a part of getting older.

How can people recognize AFib, and when should they seek care?

Dr. Day: The best thing people can do to guard against the serious complications associated with atrial fibrillation is to be aware of the signs.

Today, many smartwatches can alert users to an irregular heart rhythm, and some are even equipped with a built-in ECG function. If you feel something unusual with your heart or suspect you may be having an episode of atrial fibrillation, that technology can be useful information you can share with your doctor.

If you’re experiencing palpitations, a rapid or irregular heartbeat or your smartwatch notifies you that you may have atrial fibrillation, don’t ignore it. Get evaluated. Your primary care physician or cardiologist can help determine whether you need additional testing or care from a heart rhythm specialist, such as a cardiac electrophysiologist. The earlier atrial fibrillation is identified and appropriately treated, the better opportunity we have to manage the condition and reduce its impact over time.

What treatment options are available for AFib?

Dr. Day: When patients are first diagnosed with atrial fibrillation, they’re typically prescribed medication to slow the heart rate. Patients at intermediate or high risk of stroke are also placed on a blood thinner to reduce that risk.

For patients with significant symptoms, anti-arrhythmic medications can help keep the heart in rhythm. However, those medications are not without risk, and are not the right long-term solution for every patient.

That’s one reason catheter ablation has become such an important treatment option. There’s no surgical incision or stitches. A small catheter is passed through a vein in the leg into the heart, where we identify and treat the areas contributing to the abnormal electrical signals that cause atrial fibrillation.

Why has pulsed field ablation been such a game changer?

Dr. Day: I’ve been in practice for 25 years, and of all the treatments I’ve seen developed for atrial fibrillation, pulsed field ablation has had a significant impact on how we can care for patients.

Traditional ablation technologies use heat or freezing to treat heart tissue. Pulsed field ablation works differently. It delivers brief electrical pulses designed to selectively target the heart cells responsible for the abnormal rhythm.

Because of the way the energy is delivered, it can reduce the risk of affecting surrounding structures such as the esophagus, lung tissue or nearby nerves. It has also allowed us to shorten procedure times significantly, which can support a faster recovery for patients. For patients who want treatment that doesn’t involve lifelong medications — they’re looking for “no AFib, no meds” — nothing tops pulsed field ablation.

How is research at HCA Healthcare helping advance AFib care?

Dr. Day: Working with cardiac electrophysiologists throughout HCA Healthcare’s network, we’ve been able to study and evaluate pulsed field ablation across a broad and diverse group of patients. This is critical to understanding how technology performs in real-world clinical practice and gives us insight into safety, effectiveness and recovery in everyday patients — not just highly selected clinical trial populations.

At the most recent Heart Rhythm Society Annual Scientific Sessions, we presented 13 research studies on pulsed field ablation, and all 13 were accepted for presentation and publication. HCA Healthcare physicians’ contributions to the field also extend to leadership within the specialty. Dr. D.J. Lakkireddy, a fellow HCA Healthcare cardiac electrophysiologist, is president-elect of the Heart Rhythm Society for 2026-2027, while I previously served as president of the organization.

Dr. Day co-authored research tied to the multicenter DISRUPT-AF registry, which formed the foundation for the 13 PFA studies presented at the 2026 Heart Rhythm Society Annual Scientific Sessions. Across thousands of real-world patients, the studies showed favorable safety outcomes for pulsed field ablation, including among older adults and patients with implanted cardiac devices. The research also demonstrated opportunities to shorten procedure times, support same-day discharge and reduce reliance on antiarrhythmic medications after treatment.

I’ve also had the opportunity to be involved in research in this space for several years. I served as a review referee for the ADVENT clinical trial, a landmark study of pulsed field ablation published in The New England Journal of Medicine in 2023, and several HCA Healthcare-affiliated physicians were among the study’s authors.

Ultimately this work in the research space is about more than advancing a procedure — it’s about improving the patient’s experience.

As we recognize AFib Awareness Month, what’s the one message you hope people remember?

Dr. Day: Don’t wait. If you’re experiencing palpitations, a rapid or irregular heartbeat or your smartwatch notifies you that you may have atrial fibrillation, get evaluated.

There’s never been a better time to talk with your doctor about treatment options for atrial fibrillation. We’ve made tremendous progress in how we identify and treat atrial fibrillation, and technologies like pulsed field ablation are giving us new ways to help appropriate patients manage the condition.

The sooner we can recognize atrial fibrillation and determine the right treatment approach, the better opportunity we have to reduce its impact and help patients get back to living their lives.