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).
- Cardiovascular Disease
- Heart Rhythm Disorders
Clinical Professor, Medicine - Cardiovascular Medicine
Fellowship:UCSF Cardiology Fellowship (2003) CA
Board Certification: Clinical Cardiac Electrophysiology, American Board of Internal Medicine (2003)
Board Certification: Cardiovascular Disease, American Board of Internal Medicine (2002)
Fellowship:LSU Health Sciences Center - Shreveport (2001) LA
Residency:New York Hospital Queens (1996) NY
Medical Education:Maulana Azad Medical College (1993) India
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
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 fibrillation.ClinicalTrials.gov Identifier: NCT00911508.
View details for DOI 10.1001/jama.2019.0692
View details for Web of Science ID 000463076800014
View details for PubMedID 30874716
Safety and outcomes of cryoablation for ventricular tachyarrhythmias: Results from a multicenter experience
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
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
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