Nitish Badhwar, MD is Professor of Medicine and Director of Cardiac Electrophysiology Training Program at Stanford University School of Medicine. Dr. Badhwar received his medical degree from Maulana Azad Medical College (University of Delhi, India). After completing his internal medicine training from New York Hospital of Queens (affiliated with Cornell Medical School), he worked as faculty in the Department of Medicine at Hospital of St. Raphael (Yale University School of Medicine). He completed Cardiac Electrophysiology training at UCSF with Dr. Scheinman. After being on faculty at UCSF for 15 years he recently joined the Arrhythmia Service at Stanford Hospital. He is a Fellow of American College of Cardiology and Heart Rhythm Society. He has been named best doctor in cardiac electrophysiology in San Francisco Magazine 3 years in a row (2015-2017). This is nominated by his peers. He was given Excellence in Teaching award in Medical Education by Academy of Medical Educators in 2015. He was an invited speaker at prestigious international meetings including Oriental Congress of Cardiology (OCC) in Shanghai, China; Cardiostim EHRA /Europace in Nice, France; Asia Pacific Heart Rhythm Society (APHRS) in Seoul, S Korea; American Heart Association Annual Scientific Session in New Orleans, LA and Indian Heart Rhythm Society in New Delhi, India.

Clinical Interest: Dr. Badhwar's clinical interest is in complex catheter ablation procedures including mapping and ventricular tachycardia (VT), atrial fibrillation (AF) and supraventricular tachycardia (SVT) including junctional variants of SVT. He started the epicardial ablation program at UCSF and also worked with Dr. Randall Lee to perform the first percutaneous epicardial left atrial appendage (LAA) ligation in the Bay Area in patients with atrial fibrillation. He has also differentiated himself in the field of electrophysiology by performing hybrid procedures with CT surgeons in patients with AF and VT. He is also involved in device implantation including pacemakers, ICD and biventricular pacing for heart failure.

Research Interest: Dr. Badhwar has published electrophysiologic characteristics of SVTs including atrial tachycardia arising from the coronary sinus musculature, para-hisian atrial tachycardia, left sided AVNRT, junctional tachycardia and nodofascicular tachycardia. He has also published on the use of nuclear medicine (ERNA) in assessing left ventricular dyssynchrony as well as optimal pacing sties in patients with heart failure requiring biventricular pacing. He has described the unique clinical characteristics of epicardial idiopathic VT arising from the cardiac crux. He has also published clinical outcomes of combining LAA ligation with catheter ablation of atrial fibrillation perform (first in human percutaneous closed chested Maze procedure) and is now part of a multi-center randomized study comparing standard ablation to ablation plus LAA ligation in patients with persistent atrial fibrillation (aMAZE trial).

Clinical Focus

  • Cardiovascular Disease
  • Heart Rhythm Disorders

Academic Appointments

Administrative Appointments

  • Director, Cardiac Electrophysiology Training Program, Stanford University School of Medicine (2018 - Present)

Professional Education

  • Fellowship: UCSF Dept of Cardiology (2003) CA
  • Board Certification: American Board of Internal Medicine, Clinical Cardiac Electrophysiology (2003)
  • Board Certification: American Board of Internal Medicine, Cardiovascular Disease (2002)
  • Fellowship: LSU Health Sciences Center - Shreveport (2001) LA
  • Residency: New York Hospital Queens (1996) NY
  • Medical Education: Maulana Azad Medical College (1993) India

Clinical Trials

  • aMAZE Study: LAA Ligation Adjunctive to PVI for Persistent or Longstanding Persistent Atrial Fibrillation Recruiting

    This study is a prospective, multicenter, randomized (2:1) controlled study to evaluate the safety and effectiveness of the LARIAT System to percutaneously isolate and ligate the Left Atrial Appendage from the left atrium as an adjunct to planned pulmonary vein isolation (PVI) catheter ablation in the treatment of subjects with symptomatic persistent or longstanding persistent atrial fibrillation. This study will be conducted in two stages: - Limited Early Stage (Stage 1): up to 250 subjects at up to 65 sites. (COMPLETED, transitioned to Stage 2) - Pivotal Stage/ Phase III (Stage 2): up to 600 subjects at up to 65 sites. (COMPLETED) All subjects from both stages will be included in the primary analysis.

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  • Pivotal Study Of A Dual Epicardial & Endocardial Procedure (DEEP) Approach Recruiting

    The objective of this study is to establish the safety and effectiveness of a dual epicardial and endocardial ablation procedure for patients presenting with Persistent Atrial Fibrillation or Longstanding Persistent Atrial Fibrillation

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Graduate and Fellowship Programs

  • Cardiac Electrophysiology (Fellowship Program)

All Publications

  • Open-Chest Ablation of Incessant Ventricular Tachycardia During Left Ventricular Assist Device Implantation. JACC. Clinical electrophysiology Shah, R. L., Hiesinger, W., Badhwar, N. 2020; 6 (7): 901–2

    View details for DOI 10.1016/j.jacep.2020.03.012

    View details for PubMedID 32703578

  • Approach to narrow complex tachycardia: non-invasive guide to interpretation and management. Heart (British Cardiac Society) Shah, R. L., Badhwar, N. 2020

    View details for DOI 10.1136/heartjnl-2019-315304

    View details for PubMedID 32303628

  • Long-term outcomes of ablation for ventricular arrhythmias in mitral valve prolapse. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing Marano, P. J., Lim, L. J., Sanchez, J. M., Alvi, R. n., Nah, G. n., Badhwar, N. n., Gerstenfeld, E. P., Tseng, Z. H., Marcus, G. M., Delling, F. N. 2020


    Prior studies reporting efficacy of radiofrequency catheter ablation for complex ventricular ectopy in mitral valve prolapse (MVP) are limited by selective inclusion of bileaflet MVP, papillary muscle only ablation, or short-term follow-up. We sought to evaluate the long-term incidence of hemodynamically significant ventricular tachycardia (VT) or fibrillation (VF) in patients with MVP after initial ablation.We studied consecutive patients with MVP undergoing ablation for complex ventricular ectopy between 2013 and 2017 at our institution. Of 580 patients with MVP, we included 15 (2.6%, 10 women; mean age 50 ± 14 years, 53% bileaflet) with complex ventricular ectopy treated with initial ablation.Over a median follow-up of 3406 (1875-6551) days or 9 years, 5 of 15 (33%) patients developed hemodynamically significant VT/VF after their initial ablation and underwent placement of an implantable cardioverter defibrillator (ICD). Three of 5 also underwent repeat ablations. Sustained VT was inducible prior to index ablation in all 5 who developed VT/VF, compared to none of the 10 patients who did not develop VT/VF after index ablation (p = 0.002). Complex ventricular ectopy at index ablation was multifocal in all 5 patients who underwent repeat intervention versus 4 of 10 patients (40%) who did not (p = 0.04). All 3 patients with subsequent VT/VF who underwent repeat ablation had a new clinically dominant focus of ventricular arrhythmia and 3 of the patients with ICD had appropriate VT/VF therapies.In the long term, a subset of MVP patients treated with ablation for ventricular arrhythmias, all with multifocal ectopy on initial EP study, develop hemodynamically significant VT/VF. Our findings suggest the progressive nature of ventricular arrhythmias in patients with MVP and multifocal ectopy.

    View details for DOI 10.1007/s10840-020-00775-1

    View details for PubMedID 32506159

  • Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation The CABANA Randomized Clinical Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Mark, D. B., Anstrom, K. J., Sheng, S., Piccini, J. P., Baloch, K. N., Monahan, K. H., Daniels, M. R., Bahnson, T. D., Poole, J. E., Rosenberg, Y., Lee, K. L., Packer, D. L., Robb, R. A., Rettmann, M. E., Martinez, B., Mascette, A., Jeffries, N., Mitchell, L., Flaker, G. G., Al-Khalidi, H. R., Silverstein, A., Ellis, A., Ussery, S. A., Moretz, K. L., Hagen, S., Anstrom, K., Baloch, K., Liu, D. M., Blount, J., Cowper, P., Knight, D., O'Neal, E. F., Holmes, D. R., Breen, J., Wilber, D., Reiffel, J., Kowey, P., Naccarelli, G., DiMarco, J. P., Davies, D., Cappato, R., Kalman, J. M., Kuck, K., Hindricks, G., Calkins, H., Stevenson, W. G., Buxton, A., Curtis, A. B., Davis, B. R., Ulrich, C. M., Lazzara, R., Peters, T., Bunch, J. T., Daubert, J., Halperin, B., Holshouser, J., Kutalek, S., Michaud, G., Mounsey, P., Wyse, G., Flaker, G., Bell, R., Greenspon, A., Logan, W., Sahota, P., Singh, N., Calkins, H., Schilling, R., Verma, A., Bahnson, T., DeVille, B., Monahan, K., DiMarco, J., Naccarelli, G., Gonzalez, M., Monahan, K., Poole, J., Patton, K., Prutkin, J., Johnson, G., Akoum, N., Auokar, P., Blatt, J., Birgersdotter-Green, U., Cha, Y., Mulpuru, S., Noseworthy, P., Chung, M., Gleva, M., Glotzer, T., Henrikson, C., Stecker, E., Kanjwal, Y., Kron, J., Kuriachan, V., Obel, O., Ranjan, R., Rho, R., Russo, A., Sullivan, R., Tzou, W., van der Zee, S., Serdoz, L., Wilson, M., Bowen, W., Pokushalov, E., Romanov, A., Meshalkin, E., Bunch, T., Bahnson, T., Noelker, G., Packer, D., Hindricks, G., Ardashev, A., Revishvili, A., Matsonashvili, G., Vijayaraman, P., Ince, H., Piorkowski, C., Neumann, T., Veenhuyzen, G., Gehi, A., Wilber, D., Sogade, F., Pappone, C., Berman, A., Shalaby, A., Kuck, K., Halperin, B., Tholakanahalli, V., Palma, E., Holshouser, J., Badhwar, N., Rashid, H., Cameron, C., Hummel, J., Saavedra, P., Deville, B., Chun, J., Roman-Gonzalez, J., Willems, S., Garan, H., Crespo, E., Cheung, P., Groenefeld, G., Schuger, C., Salam, T., Yang, Y., Pappone, C., Wichterle, D., Brachmann, J., Kautzner, J., Jayachandran, J., Kim, Y., Cole, C., Herweg, B., Lowe, M., Dougherty, A., Popov, S., Lowe, M., Spitzer, S., Bernstein, R., Simonson, J., Buch, E., Wu, S., Khan, M., Shinn, T., Neuzil, P., Mangrum, J., Calkins, H., Gonzalez, M., Mansour, M., Zabel, M., Kalman, J., Sanchez, J., Rothman, S., Bhandari, A., Tracy, C., Mitrani, R., Vorperian, V., Connelly, D., Wells, D., Ma, C., Verma, A., Robinson, M., Rubenstein, D., Vanoli, E., Zhang, S., Cummings, J., Viswanathan, M., Monir, G., Marchlinski, F., Franklin, J., Koplan, B., Sanders, P., Rashba, E., Gallagher, M., Gonska, B., Chen, M., Leong-Sit, P., Zimmerman, J., Pezeshkian, N., Cohen, A., Kalvaitis, S., Davies, D., Borggrefe, M., Pak, H., Russo, A., Henrikson, C., Greer, G., Coromilas, J., Khairallah, F., Sosa-Suarez, G., Lindsay, B., Fisher, W., Bailin, S., Tran, A., Starek, Z., Preminger, M., Sheppard, R., Costea, A., Ellenbogen, K., Arentz, T., De Ponti, R., Aleong, R., Colley, B., Baig, K., Krishnan, K., Menon, S., Simmons, T., Bruce, G., Chinitz, L., Natale, A., Cappato, R., CABANA Investigators, CABANA Rhythm Monitoring, Clinical Site Principal Investigat 2019; 321 (13): 1275–85


    Catheter ablation is more effective than drug therapy in restoring sinus rhythm in patients with atrial fibrillation (AF), but its incremental effect on long-term quality of life (QOL) is uncertain.To determine whether catheter ablation is more beneficial than conventional drug therapy for improving QOL in patients with AF.An open-label randomized clinical trial of catheter ablation vs drug therapy in 2204 symptomatic patients with AF older than 65 years or 65 years or younger with at least 1 risk factor for stroke. Patients were enrolled from November 2009 to April 2016 from 126 centers in 10 countries. Follow-up ended in December 2017.Pulmonary vein isolation, with additional ablation procedures at the discretion of the investigators, for the catheter ablation group (n = 1108) and standard rhythm and/or rate-control drugs selected and managed by investigators for the drug therapy group (n = 1096).Prespecified co-primary QOL end points at 12 months, including the Atrial Fibrillation Effect on Quality of Life (AFEQT) summary score (range, 0-100; 0 indicates complete disability and 100 indicates no disability; patient-level clinically important difference, ≥5 points) and the Mayo AF-Specific Symptom Inventory (MAFSI) frequency score (range, 0-40; 0 indicates no symptoms and 40 indicates the most severe symptoms; patient-level clinically important difference, ≤-1.6 points) and severity score (range, 0-30; 0 indicates no symptoms and 30 indicates the most severe symptoms; patient-level clinically important difference, ≤-1.3 points).Among 2204 randomized patients (median age, 68 years; 1385 patients [63%] were men, 946 [43%] had paroxysmal AF, and 1256 [57%] had persistent AF), the median follow-up was 48.5 months, and 1968 (89%) completed the trial. The mean AFEQT summary score was more favorable in the catheter ablation group than the drug therapy group at 12 months (86.4 points vs 80.9 points) (adjusted difference, 5.3 points [95% CI, 3.7-6.9]; P < .001). The mean MAFSI frequency score was more favorable for the catheter ablation group than the drug therapy group at 12 months (6.4 points vs 8.1 points) (adjusted difference, -1.7 points [95% CI, -2.3 to -1.2]; P < .001) and the mean MAFSI severity score was more favorable for the catheter ablation group than the drug therapy group at 12 months (5.0 points vs 6.5 points) (adjusted difference, -1.5 points [95% CI, -2.0 to -1.1]; P < .001).Among patients with symptomatic atrial fibrillation, catheter ablation, compared with medical therapy, led to clinically important and significant improvements in quality of life at 12 months. These findings can help guide decisions regarding management of atrial Identifier: NCT00911508.

    View details for DOI 10.1001/jama.2019.0692

    View details for Web of Science ID 000463076800014

    View details for PubMedID 30874716

  • Long-term clinical outcomes from real-world experience of left atrial appendage exclusion with LARIAT device. Journal of cardiovascular electrophysiology Parikh, V. n., Bartus, K. n., Litwinowicz, R. n., Turagam, M. K., Sadowski, J. n., Kapelak, B. n., Bartus, M. n., Podolec, J. n., Brzezinski, M. n., Musat, D. n., Rasekh, A. n., Mittal, S. n., Cheng, J. n., Badhwar, N. n., Lee, R. n., Lakkireddy, D. n. 2019; 30 (12): 2849–57


    Left atrial appendage closure (LAAC) with LARIAT has emerged as one of the alternatives to oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (AF). Our aim was to study long-term outcomes in patients undergoing LARIAT procedure.We analyzed patients screened for LARIAT device in four centers between December 2009 and June 2012. Out of these, patients who didn't undergo LAAC with the LARIAT device due to unfavorable LAA morphology and other preprocedural contraindications were included in control group. We analyzed thromboembolism, bleeding events, and mortality between LAA and control group.About 153 patients were screened. Out of these, 108 (70.6%) patients underwent LARIAT placement (LAA arm) and 45 (29.4%) excluded patients were included in control arm. There were no differences in CHADS2 and CHA2 DS2 -VASc score. Mean HAS-BLED score was significantly higher in the LARIAT group (3.5 ± 1.06 vs 3.09 ± 1.22, P = .04). Mean follow-up time (in years) was 6.56 ± 0.84 in LAA and 6.5 ± 1.26 in control arm. During follow-up period, the LARIAT group was associated with significantly less thromboembolic events (1.9% vs 24%, P < .001), bleeding events (9.2% vs 24.4%, P = .03), and mortality (5.6% vs 20%, P = .01) as compared with the control group.Long-term data from routine clinical practice from our study suggests that LAA exclusion with LARIAT device is an effective treatment in management of nonvalvular AF patients with high risk of stroke, bleeding, and mortality. Further randomized trials, such as aMAZE, will provide more insight in this expanding field.

    View details for DOI 10.1111/jce.14229

    View details for PubMedID 31596044

  • Hybrid and surgical procedures for the treatment of persistent and longstanding persistent atrial fibrillation. Expert review of cardiovascular therapy Sanchez, J. M., Al-Dosari, G. n., Chu, S. n., Beygui, R. n., Deuse, T. n., Badhwar, N. n., Lee, R. J. 2018; 16 (2): 91–97


    Atrial fibrillation (AF) is the most common cardiac arrhythmia. The incidence of AF increases with age and is associated with increased stroke, heart failure and mortality. Persistent and long standing persistent AF is difficult to treat and often refractory to medical therapy and catheter ablation. Areas covered: This article reviews the historical development of the surgical Cox-MAZE procedure and current hybrid and minimally invasive surgical approaches for the treatment of persistent and long standing persistent AF. The role of concomitant pulmonary vein isolation and left atrial appendage (LAA) exclusion will also be reviewed. Expert commentary: An ablation pattern emulating the Cox-Maze surgical procedure is commonly needed to obtain maintenance of sinus rhythm in patients with persistent and long standing persistent atrial fibrillation. Minimally invasive bilateral thorascopic surgical procedures can achieve a similar Cox-Maze lesion set, but are associated with increased adverse events compared to catheter ablation. Future prospective randomized studies are required to confirm whether the recently developed hybrid subxyphoid epicardial/endocardial procedure and percutaneous LAA ligation and catheter ablation are indeed as effective as surgical options with less adverse events.

    View details for DOI 10.1080/14779072.2018.1425140

    View details for PubMedID 29327638

  • Supraventricular tachycardia with shifting atrial activation patterns caused by extrastimuli: What is the mechanism? Journal of cardiovascular electrophysiology Chandh Raja, D., Nair, K. K., Badhwar, N., Pandurangi, U. M. 2020


    A 45-year old female presented with recurrent symptomatic palpitations responsive to adenosine. An electrophysiology study was performed with decapolar catheter in the coronary sinus (CS) and quadripolar catheters in the His and right ventricular (RV) apex. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1111/jce.14669

    View details for PubMedID 32656885

  • Ablation of Supraventricular Tachycardias From Concealed Left-sided Nodoventricular And Nodofascicular Accessory Pathways. Circulation. Arrhythmia and electrophysiology Cardona-Guarache, R., Han, F. T., Nguyen, D. T., Chicos, A. B., Badhwar, N., Knight, B. P., Johnson, C. J., Heaven, D., Scheinman, M. M. 2020


    Background - Nodoventricular (NV) and nodofascicular (NF) accessory pathways (AP) are uncommon connections between the AV node and the fascicles or ventricles. Methods - Five patients with NF or NV tachycardia were studied. Results - We identified 5 patients with concealed, left-sided NV (n=4) and NF (n=1) AP. We proved the participation of AP in tachycardia by delivering His-synchronous PVCs that either delayed the subsequent atrial electrogram or terminated the tachycardia (n=3), and by observing an increase in VA interval coincident with left bundle branch block (LBBB) (n=2). The APs were not atrioventricular pathways because the septal VA interval during tachycardia was <70ms in 3, 1 had spontaneous AV dissociation, and in 1 the atria were dissociated from the circuit with atrial overdrive pacing. Entrainment from the right ventricle showed ventricular fusion in 4 out of 5 cases. A left-sided origin of the AP was suspected after failed ablation of the right inferior extension of AV node in 3 cases and by observing a VA increase with LBBB in 2 cases. The NF and 3 of the NV AP were successfully ablated from within the proximal coronary sinus (CS) guided by recorded potentials at the roof of the CS, and 1 NV AP was ablated via a transseptal approach near the CS os. Conclusions - Left-sided NF and NV AP appear to connect the ventricles with the CS musculature in the region of the CS os. Mapping and successful ablation sites can be guided by recording potentials within or near the CS os.

    View details for DOI 10.1161/CIRCEP.119.007853

    View details for PubMedID 32286853

  • An Irregular Rhythm: What Is the Mechanism? JACC. Clinical electrophysiology Higuchi, S. n., Kumar, U. N., Badhwar, N. n., Tchou, P. n., Scheinman, M. M. 2020; 6 (9): 1205–11

    View details for DOI 10.1016/j.jacep.2020.08.006

    View details for PubMedID 32972562

  • Variable Presentations and Ablation Sites for Manifest Nodoventricular/Nodofascicular Fibers. Circulation. Arrhythmia and electrophysiology Nazer, B., Walters, T. E., Dewland, T. A., Naniwadekar, A., Koruth, J. S., Najeeb Osman, M., Intini, A., Chen, M., Biermann, J., Steinfurt, J., Kalman, J. M., Tanel, R. E., Lee, B. K., Badhwar, N., Gerstenfeld, E. P., Scheinman, M. M. 2019; 12 (9): e007337


    BACKGROUND: Nodofascicular and nodoventricular (NFV) accessory pathways connect the atrioventricular node and the Purkinje system or ventricular myocardium, respectively. Concealed NFV pathways participate as the retrograde limb of supraventricular tachycardia (SVT). Manifest NFV pathways can comprise the anterograde limb of wide-complex SVT but are quite rare. The purpose of this report is to highlight the electrophysiological properties and sites of ablation for manifest NFV pathways.METHODS: Eight patients underwent electrophysiology studies for wide-complex tachycardia (3), for narrow-complex tachycardia (1), and preexcitation (4).RESULTS: NFV was an integral part of the SVT circuit in 3 patients. Cases 1 to 2 were wide-complex tachycardia because of manifest NFV SVT. Case 3 was a bidirectional NFV that conducted retrograde during concealed NFV SVT and anterograde causing preexcitation during atrial pacing. NFV was a bystander during atrioventricular node re-entrant tachycardia, atrial fibrillation, atrial flutter, and orthodromic atrioventricular re-entrant tachycardia in 4 cases and caused only preexcitation in 1. Successful NFV ablation was achieved empirically in the slow pathway region in 1 case. In 5 cases, the ventricular insertion was mapped to the slow pathway region (2 cases) or septal right ventricle (3 cases). The NFV was not mapped in cases 5 and 7 because of its bystander role. QRS morphology of preexcitation predicted the right ventricle insertion sites in 4 of the 5 cases in which it was mapped. During follow-up, 1 patient noted recurrent palpitations but no documented SVT.CONCLUSIONS: Manifest NFV may be critical for wide-complex tachycardia/manifest NFV SVT, act as the retrograde limb for narrow-complex tachycardia/concealed NFV SVT, or cause bystander preexcitation. Ablation should initially target the slow pathway region, with mapping of the right ventricle insertion site if slow pathway ablation is not successful. The QRS morphology of maximal preexcitation may be helpful in predicting successful right ventricle ablation site.

    View details for DOI 10.1161/CIRCEP.119.007337

    View details for PubMedID 31505948

  • Intentional pneumothorax avoids collateral damage: Dynamic phrenic nerve mobilization through intrathoracic insufflation of carbon dioxide. HeartRhythm case reports Shah, R. L., Perino, A. n., Obafemi, O. n., Lee, A. n., Badhwar, N. n. 2019; 5 (9): 480–84

    View details for DOI 10.1016/j.hrcr.2019.07.007

    View details for PubMedID 31934546

    View details for PubMedCentralID PMC6951311

  • Subxiphoid Hybrid Approach for Epicardial/Endocardial Ablation and LAA Exclusion in Patients with Persistent and Longstanding Atrial Fibrillation. Journal of atrial fibrillation Badhwar, N. n., Al-Dosari, G. n., Dukes, J. n., Lee, R. J. 2018; 11 (1): 2014


    Two patients with long-standing atrial fibrillation (AF) refractory to medical management and with prior pulmonary vein isolation underwent a new hybrid epicardial/endocardial subxyphoid approach for AF ablation and left atrial appendage (LAA) ligation. Pulmonary vein and LA posterior wall isolation, as well as LAA exclusion were achieved in both patients. There were no procedural complications. Both patients remain in sinus rhythm. Both patients are off antiarrhythmic medications.

    View details for DOI 10.4022/jafib.2014

    View details for PubMedID 30455837

    View details for PubMedCentralID PMC6207232

  • Surface ECG and intracardiac spectral measures predict atrial fibrillation recurrence after catheter ablation. Journal of cardiovascular electrophysiology Szilágyi, J. n., Walters, T. E., Marcus, G. M., Vedantham, V. n., Moss, J. D., Badhwar, N. n., Lee, B. n., Lee, R. n., Tseng, Z. H., Gerstenfeld, E. P. 2018; 29 (10): 1371–78


    Outcome of patients undergoing catheter ablation of atrial fibrillation (AF) varies widely. We sought to investigate whether parameters derived from the spectral analysis of surface ECG and intracardiac AF electrograms can predict outcome in patients referred for pulmonary vein isolation (PVI).We performed spectral analysis on the surface ECG and intracardiac electrograms from patients referred for AF ablation. After filtering and QRST subtraction, we measured the dominant frequency (DF), regularity index (RI) and the organizational index (OI) of fibrillatory electrograms and determined their value for predicting AF recurrence after ablation. A subjective, blinded prediction based on the surface ECG was also performed.We analyzed data from 153 PVI procedures in 140 patients (67.1% with persistent or longstanding AF). In a multivariable model, DF in the right atrium (RA) and distal coronary sinus (CSd)-to-RA DF gradient predicted AF recurrence (OR, 3.52, P = 0.023 and OR, 0.2, P = 0.034, respectively). DF in RA and CSd to RA DF gradient had a good predictive value for PVI outcome (area under the curve [AUC] of 0.73, P = 0.007 and 0.74, P = 0.007, respectively). These performed better than the subjective predictions of experienced electrophysiologists ( P = 0.2).Higher RA DF, lower CSd to RA DF gradient predicted recurrence after AF ablation. These spectral measures suggest a more remodeled atrial substrate and may provide simple tools for risk stratification or predict the need for additional substrate modification in patients referred for AF ablation.

    View details for DOI 10.1111/jce.13699

    View details for PubMedID 30016007

  • Anatomical and electrical remodeling with incomplete left atrial appendage ligation: Results from the LAALA-AF registry. Journal of cardiovascular electrophysiology Turagam, M. n., Atkins, D. n., Earnest, M. n., Lee, R. n., Nath, J. n., Ferrell, R. n., Bartus, K. n., Badhwar, N. n., Rasekh, A. n., Cheng, J. n., Di Biase, L. n., Natale, A. n., Wilber, D. n., Lakkireddy, D. n. 2017; 28 (12): 1433–42


    The anatomical, electrical, and clinical impact of incomplete Lariat left atrial appendage ligation remains unclear.We studied LAA anatomy pre- and postligation using contrast enhanced-computed tomography (CT) scans in 91 patients with atrial fibrillation (AF) who subsequently underwent catheter ablation (CA).Eleven patients had an incomplete exclusion (12%) with a central leak ranging from 1 to 5 mm. Despite incomplete ligation; the LAA volume were reduced by 67% postprocedurally when compared to preprocedure. In 7 patients with a leak between 1 and 3 mm, there was a 77% reduction in LAA volume beyond the ligation site suggestive of remodeling of the LAA. In 4 patients with larger (4-5 mm) leak the LAA remnants (LAARs) were slightly larger than those with smaller leaks on follow-up CT scan. Three out of the 4 demonstrated LAA electrical activity during CA and underwent isolation of the LAA ostium. Follow-up imaging showed two of these LAARs completely sealed with no communication with the left atrium. There was no significant difference in the AF recurrence rates between the patients who had a leak versus those with complete ligation (4 of 11 [36%] vs. 22 of 80 [27%]; P  =  0.6). Oral anticoagulation was discontinued in all patients with small leaks and 2 patients with large leaks that sealed completely upon follow-up imaging. There were no strokes or TIAs at 12 months.Despite incomplete LAA ligation by Lariat device there is significant anatomical and electrical remodeling that resulted in reduction in LAA size, volume, and electrical activity.

    View details for DOI 10.1111/jce.13343

    View details for PubMedID 28940485

  • Post-cardioversion ST-segment elevation: a case-based review of the pathophysiology. Journal of thoracic disease Divanji, P. n., Badhwar, N. n., Goldschlager, N. n. 2017; 9 (12): 5503–6

    View details for DOI 10.21037/jtd.2017.11.82

    View details for PubMedID 29312760

    View details for PubMedCentralID PMC5757058

  • Clinical Features and Sites of Ablation for Patients With Incessant Supraventricular Tachycardia From Concealed Nodofascicular and Nodoventricular Tachycardias. JACC. Clinical electrophysiology Han, F. T., Riles, E. M., Badhwar, N. n., Scheinman, M. M. 2017; 3 (13): 1547–56


    This study sought to describe the clinical features and sites of successful ablation for incessant nodofascicular (NF) and nodoventricular (NV) tachycardias.Incessant supraventricular tachycardias have been associated with tachycardia-induced cardiomyopathies and have been previously attributed to permanent junctional reciprocating tachycardias, atrial tachycardias, and atrioventricular nodal re-entrant tachycardias. Incessant concealed NF and NV tachycardias have not been described previously.Three cases of incessant concealed NF and NV re-entrant tachycardias were identified from 2 centers.The authors describe 3 cases with incessant supraventricular tachycardia resulting from NV (2 cases) and NF (1 case) pathways. Atrioventricular nodal re-entrant tachycardia was excluded by His synchronous premature ventricular complexes that either delayed or terminated the tachycardia. Ventricular pacing showed constant and progressive fusion in cases 1 and 3. In 2 cases, there was spontaneous initiation with a 1:2 response (cases 1 and 3); the presence of retrograde longitudinal dissociation or marked decremental pathway conduction in cases 1 and 3 sustains these tachycardias. The NV pathway was successfully ablated in the slow pathway region in case 3 and at the right bundle branch in case 1. The NF pathway was successfully ablated within the proximal coronary sinus in case 2.This is the first report of incessant supraventricular tachycardia using concealed NF or NV pathways. These tachycardias demonstrated spontaneous initiation from sinus rhythm with a 1:2 response and retrograde longitudinal dissociation or marked decremental pathway conduction. Successful ablation was achieved at either right-sided sites or within the coronary sinus.

    View details for DOI 10.1016/j.jacep.2017.07.015

    View details for PubMedID 29759837

  • Safety and outcomes of cryoablation for ventricular tachyarrhythmias: Results from a multicenter experience HEART RHYTHM Di Biase, L., Al-Ahamad, A., Santangeli, P., Hsia, H. H., Sanchez, J., Bai, R., Bailey, S., Horton, R., Gallinghouse, G. J., Burkhardt, D. J., Lakkireddy, D., Yang, Y., Badhwar, N., Scheinman, M., Tung, R., Dello Russo, A., Pelargonio, G., Casella, M., Tomassoni, G., Shivkumar, K., Natale, A. 2011; 8 (7): 968-974


    Catheter ablation of ventricular arrhythmias (VAs) with cryoenergy has not been widely reported.The purpose of this study was to assess the feasibility and safety of cryoablation for VA.Cases where cryoablation of VA was attempted as the initial strategy or was considered to prevent potential damage to other structures such as the coronary arteries, phrenic nerve, and His bundle were collected. Thirty-three patients with either normal heart or structural heart disease undergoing VA ablation using cryoenergy at six different institutions were enrolled in the study. Epicardial access was obtained when appropriate.Fifteen patients (7 men) underwent endocardial ablation, 13 (9 men) epicardial ablation (from the coronary sinus in 7), and 5 (2 men) aortic cusp ablation. Mean age was 54 ± 8 years, and ejection fraction was 45% ± 5%. In 15 (45%) patients, VAs were successfully ablated, whereas cryoablation was unsuccessful in the remaining 18 (55%) patients. Cryoablation was successful in all parahisian cases (100%). In three patients, epicardial cryoablation was successful after several failed attempts with open irrigated catheter. An aortic dissection occurred during catheter placement in the aortic cusp. At follow-up of 24 ± 5 months, all patients with acute success were free from clinical VA.Use of cryoenergy for ablation of VA has excellent success for arrhythmias near the His bundle; however, success rates at other sites appear less favorable. Cryoablation may be considered as an alternative approach for reducing complications during ablation of VAs originating from sites close to other relevant cardiac structures (conduction system, coronary arteries, phrenic nerve) and, in rare cases, could be used epicardially when radiofrequency energy applications have failed.

    View details for DOI 10.1016/j.hrthm.2011.02.038

    View details for Web of Science ID 000292243400007

    View details for PubMedID 21376835

  • Wolff-Parkinson-White syndrome: where is the pathway? Indian pacing and electrophysiology journal Turakhia, M. P., Scheinman, M., Badhwar, N. 2009; 9 (2): 130-133


    A 31-year old male presented with atrial fibrillation and ventricular preexcitation that was positive in leads V1-V4, negative in lead II, and positive in lead AVR. The patient was cardioverted and invasive electrophysiologic study was performed. Based on the ECG findings, the coronary sinus and its branches were interrogated during orthodromic atrioventricular reentrant tachycardia. The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch. Radiofrequency energy application at this area led to loss of preexcitation. When localizing left septal and posterior accessory pathways, ventricular preexcitation that is both negative in II and positive in AVR has been shown in previous studies to be highly sensitive and specific for a subepicardial location. Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.

    View details for PubMedID 19308285

  • Impact of advanced age on survival in patients with implantable cardioverter defibrillators EUROPACE Pellegrini, C. N., Lee, K., Olgin, J. E., Turakhia, M. P., Tseng, Z. H., Lee, R., Badhwar, N., Lee, B., Varosy, P. D. 2008; 10 (11): 1296-1301


    Given the selectivity of clinical trial patients and meager representation of elderly in the major implantable cardioverter defibrillator (ICD) randomized trials (<25%), whether such data apply to elderly patients overall is unclear. The purpose of our study is to understand the influence of age on mortality after ICD implantation.We performed a retrospective cohort study of 502 consecutive patients receiving ICDs from 1993 to 2003 at a single university hospital. The primary predictor was patient age, categorized as <65, 65-75, and >75 years at ICD implantation. The primary outcome was time to death. Mean follow-up was 4 years. Median survival after ICD implantation was 5.3 years among subjects >75 years, less than half that of the youngest group. After adjusting for potential confounders, compared with subjects <65 years of age, patients >75 years [hazard ratio (HR), 4.7; 95% confidence interval (CI), 2.8-7.9; P < 0.001] and those 65-75 years (HR, 2.8; 95% CI, 1.7-4.8; P < 0.001) were at greater risk of death. Increased age was associated with higher total, cardiac, and non-cardiac mortality (all P

    View details for DOI 10.1093/europace/eun253

    View details for Web of Science ID 000260556300009

    View details for PubMedID 18818212

    View details for PubMedCentralID PMC2721725