Rajan Lalit Shah
Affiliate, Medicine - Med/Cardiovascular Medicine
Bio
Dr. Rajan Shah is a cardiac electrophysiologist concentrating on the treatment of arrhythmias, especially those of complex origins. He prides himself on delivering personalized attention, compassion, and high-quality care to optimize the needs of his patients with abnormal heart rhythms. His experiences in Detroit, where he was raised, exposed him to a wide range of beautiful cultures and backgrounds, and solidified his decision to pursue a career focused on the wellbeing of people.
He completed his sub-specialty fellowship at Stanford University where he received 2 years of highly specialized training dedicated to the treatment of genetic arrhythmia syndromes and management of complex heart rhythm disorders. Dr. Shah continues his profession at Stanford Health Care and is grateful for the opportunity to care for a diverse population, employing his expertise in state-of-the-art therapies including minimally-invasive catheter ablation (ex: ventricular tachycardia, atrial fibrillation) and device implantation (ex: conduction system and leadless pacing) to better the health outcomes of his patients with various arrhythmias. In his clinical role, Dr. Shah additionally directs the East Bay Familial Inherited Arrhythmia Clinic concentrated on the tailored-treatment of genetic arrhythmia syndromes and the prevention of sudden cardiac death in individuals and families.
Clinical Focus
- Cardiac Electrophysiology
- Cardiovascular Disease
Administrative Appointments
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Director, Familial Inherited Arrhythmia (FIA) Program, East Bay (2020 - Present)
Professional Education
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Board Certification: National Board of Echocardiography, Adult Echocardiography (2017)
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Fellowship, Stanford University, Clinical Cardiac Electrophysiology Fellowship (2020)
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Fellowship, Henry Ford Health System, Cardiovascular Medicine Fellowship (2018)
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Residency, University of Southern California, Internal Medicine Residency (2015)
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Medical Education, Wayne State University School of Medicine, Doctor of Medicine (2012)
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Board Certification: American Board of Internal Medicine, Clinical Cardiac Electrophysiology (2021)
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Board certification, American Board of Internal Medicine, Cardiac Electrophysiology (2021)
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Board Certification: American Board of Internal Medicine, Cardiovascular Disease (2018)
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Board Certification: American Board of Internal Medicine, Internal Medicine (2015)
All Publications
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Mapping Atrial Fibrillation After Surgical Therapy to Guide Endocardial Ablation.
Circulation. Arrhythmia and electrophysiology
2022: 101161CIRCEP121010502
Abstract
Surgical ablation for atrial fibrillation (AF) can be effective, yet has mixed results. It is important to improve the success of AF surgery, yet unclear which endocardial lesions will best augment surgical lesion sets in individual patients. We addressed this question by systematically mapping AF endocardially after surgical ablation and relating findings to early recurrence.We studied 81 consecutive patients undergoing epicardial surgical ablation (stage 1 hybrid), of whom 64 proceeded to endocardial catheter mapping and ablation (stage 2). Stage 2 comprised high-density mapping of pulmonary vein (PV) or posterior wall (PW) reconnections, low-voltage zones (LVZs), and potential localized AF drivers. We related findings to postsurgical recurrence of AF.Mapping at stage 2 revealed PW isolation reconnection in 59.4%, PV isolation reconnection in 28.1%, and LVZ in 42.2% of patients. Postsurgical recurrence of AF occurred in 36 patients (56.3%), particularly those with long-standing persistent AF (P=0.017), but had no relationship to reconnection of PVs (P=0.53) or PW isolation (P=0.75) when compared with those without postsurgical recurrence of AF. LVZs were more common in patients with postsurgical recurrence of AF (P=0.002), long-standing persistent AF (P=0.002), advanced age (P=0.03), and elevated CHA2DS2-VASc (P=0.046). AF mapping revealed 4.4±2.7 localized focal/rotational sites near and also remote from PV or PW reconnection. After ablation at patient-specific targets, arrhythmia freedom at 1 year was 81.0% including and 73.0% excluding previously ineffective antiarrhythmic medications.After surgical ablation, AF may recur by several modes including recovery of PW or PV isolation, mechanisms related to localized LVZ, or other sustaining mechanisms. LVZs are more common in patients at high clinical risk for recurrence. Patient-specific targeting of these mechanisms yields excellent long-term outcomes from hybrid ablation.
View details for DOI 10.1161/CIRCEP.121.010502
View details for PubMedID 35622437
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Hybrid Ablation for Atrial Fibrillation: Safety & Efficacy of Unilateral Epicardial Access.
Seminars in thoracic and cardiovascular surgery
2022
Abstract
Hybrid ablation combines thoracoscopic epicardial ablation with percutaneous catheter based endocardial ablation for the treatment of AF. The purpose of this study was to evaluate the safety and efficacy of hybrid ablation surgery for the treatment of atrial fibrillation (AF), and to compare outcomes of unilateral versus bilateral thoracoscopic epicardial ablation. Patients with documented AF who underwent hybrid ablation were followed post-operatively for major events. Major events were classified into two categories consisting of 1) safety, comprising all-cause mortality and major morbidities, and 2) efficacy, which included recurrence of atrial arrhythmia, cessation of antiarrhythmic drugs (AAD), and completeness of lesion set. A total of 84 consecutive patients were consented for hybrid ablation. Patients presented with an average AF duration of 85.9 months before hybrid ablation. 80 patients underwent successful thoracoscopic epicardial ablation. At one-year, 87% (60/69) of patients were free from AF and 73% (50/69) were free from AF and off AAD. 63 patients completed both epicardial and endocardial hybrid ablation with posterior wall isolation achieved in 89% (56/63) of patients. Unilateral epicardial ablation was associated with significantly shorter hospital length of stay compared to bilateral surgical approached (3.9 vs. 6.7 days, p = 0.002) with no difference in freedom from AF between groups at 1 year. Hybrid ablation for atrial fibrillation is effective for patients at high risk for recurrence after catheter ablation. The unilateral surgical approach may be associated with shorter hospital stay with no appreciable effect on procedure success rates. This study evaluates the safety and efficacy of unilateral epicardial access for hybrid ablation in patients with symptomatic atrial fibrillation refractory to antiarrhythmic treatment. Hybrid ablation for atrial fibrillation is effective for patients at high risk for recurrence after catheter ablation. The unilateral surgical approach may be associated with shorter hospital stay with no appreciable effect on procedure success rates.
View details for DOI 10.1053/j.semtcvs.2022.03.003
View details for PubMedID 35278664
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Substrate Characterization and Outcomes of Ventricular Tachycardia Ablation in Titin Cardiomyopathy: A Multicenter Study.
Circulation. Arrhythmia and electrophysiology
2021
Abstract
Background - Truncating variants of the titin gene (TTNtv) are a leading cause of dilated cardiomyopathy (DCM) and have been associated with an increased risk of ventricular arrhythmias. This study evaluated the substrate distribution and the acute and long-term outcomes of patients with TTN-related cardiomyopathy undergoing ventricular tachycardia (VT) ablation. Methods - This multicenter registry included 15 patients with DCM (age 59±11 years, 93% male, ejection fraction 30±12%) and genotypically confirmed TTNtvs who underwent VT ablation between July 2014 and July 2020. Results - All patients presented with sustained monomorphic VT, including electrical storm in 4 of them. A median of 2 VTs per patient were induced during the procedure (cycle-length 318±68 ms) and the predominant morphologies were left bundle branch block with inferior axis (39%) and right bundle branch block with inferior axis (29%). A complete map of the left ventricle (LV) was created in 12 patients and showed voltage abnormalities mainly at the periaortic (92%) and basal septal region (58%). A preprocedural cardiac magnetic resonance imaging was available in 13 patients and in 11 there was evidence of LV delayed gadolinium enhancement, with predominantly midmyocardial distribution. Sequential ablation from both sides of the septum was required in 47% of patients to target septal intramural substrate and epicardial ablation was performed in 20%. At the end of the procedure, the clinical VT was noninducible in all patients, while in 3 cases a non-clinical VT was still inducible. After a follow-up of 26.5±23.0 months, 53% of patients experienced VT recurrence, 20% received transplant or mechanical circulatory support and 7% died. Conclusion - The arrhythmogenic substrate in TTN-related cardiomyopathy involves the basal septal and perivalvular regions. Long-term outcomes of catheter ablation are modest, with high recurrence rate, likely related to an intramural location of VT circuits.
View details for DOI 10.1161/CIRCEP.121.010006
View details for PubMedID 34315225
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Antiarrhythmic drug loading at home using remote monitoring: a virtual feasibility study during COVID-19 social distancing.
European heart journal. Digital health
2021; 2 (2): 259-262
Abstract
The epidemiological necessity for distancing during the COVID-19 pandemic has resulted in postponement of non-emergent hospitalizations and increase use of telemedicine. The feasibility of virtual antiarrhythmic drug (AAD) loading specifically with digital QTc electrocardiographic monitoring (EM) in conjunction with telemedicine video visits is not well established. We tested the hypothesis that existing digital health technologies and virtual communication platforms could provide EM and support medically guided AAD loading for patients with symptomatic tachyarrhythmia in the ambulatory setting, while reducing physical contact between patient and healthcare system. A prospective pilot, case series was approved by the institutional ethics committee, entailing three subjects with symptomatic arrhythmia during the COVID-19 pandemic who were enrolled for virtual AAD loading at home. Clinicians met with participants twice daily via video visits conducted after QTc analysis (Kardia 6L mobile sensor) and telemetry review (Mobile Cardiac Outpatient Telemetry of silent arrhythmias). Participants received direct instruction to either terminate the study or proceed with the next single dose of AAD. All participants completed contactless loading of five AAD doses, without untoward event. Scheduled video visits allowed dialogue and participant counselling where decision-making was guided by remote review of EM. Participant adherence with transmissions and scheduled visits was 98.3%; a single electrocardiogram was delayed beyond the 2 hours of post-dose schedule. This virtual approach reduced overall expenditures based on retrospective comparison with previous AAD load hospitalizations. We found that a 'virtual hospitalization' for AAD loading with remote EM and twice-daily virtual rounding is feasible using existing digital health technologies.
View details for DOI 10.1093/ehjdh/ztab034
View details for PubMedID 37155657
View details for PubMedCentralID PMC8083679
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Deformation of stylet-driven leads & helix unraveling during acute explant after conduction system pacing.
Indian pacing and electrophysiology journal
2021
View details for DOI 10.1016/j.ipej.2021.06.001
View details for PubMedID 34118434
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Open-Chest Ablation of Incessant Ventricular Tachycardia During Left Ventricular Assist Device Implantation.
JACC. Clinical electrophysiology
2020; 6 (7): 901–2
View details for DOI 10.1016/j.jacep.2020.03.012
View details for PubMedID 32703578
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How Will Genetics Inform the Clinical Care of Atrial Fibrillation?
CIRCULATION RESEARCH
2020; 127 (1): 111–27
View details for DOI 10.1161/CIRCRESAHA.120.316365
View details for Web of Science ID 000544633300008
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Approach to narrow complex tachycardia: non-invasive guide to interpretation and management.
Heart (British Cardiac Society)
2020
View details for DOI 10.1136/heartjnl-2019-315304
View details for PubMedID 32303628
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Pathological overlap of Arrhythmogenic Right Ventricular Cardiomyopathy and Cardiac Sarcoidosis.
Circulation. Genomic and precision medicine
2019
Abstract
A previously healthy 50-year-old female long-distance runner initially presented to the emergency room with sustained palpitations and was found to be in a hemodynamically stable wide complex tachycardia at 220 bpm. Initial electrocardiogram (ECG) demonstrated monomorphic tachycardia with a right inferoapical ventricular origin (Figure 1A). Echocardiogram revealed normal left ventricular (LV) size and moderately reduced function, but severe right ventricular (RV) enlargement and systolic dysfunction in the absence of elevated pulmonary pressures (Figure 1B). Her ECG in normal sinus rhythm showed T wave inversions in V1-V4 (Figure 1C) and her signal averaged ECG was abnormal with a filtered QRS duration of 150 msec, root mean square amplitude of the last 40 msec of late potentials (RMS40) of 2.16 mV and duration of low amplitude signal (LAS) of 92.5msec. Electrophysiology study confirmed inducible ventricular arrhythmias from the RV, and internal cardiac defibrillator (ICD) was placed.
View details for DOI 10.1161/CIRCGEN.119.002638
View details for PubMedID 31542937
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Catheter ablation or surgery to eliminate longstanding persistent atrial fibrillation.
International journal of cardiology
2019
View details for DOI 10.1016/j.ijcard.2019.12.048
View details for PubMedID 31924396
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Intentional pneumothorax avoids collateral damage: Dynamic phrenic nerve mobilization through intrathoracic insufflation of carbon dioxide.
HeartRhythm case reports
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
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Three-Dimensional Printing for Planning of Structural Heart Interventions.
Interventional cardiology clinics
2018; 7 (3): 415-423
Abstract
Three-dimensional (3D) printing is a process leading to the creation of a physical 3D model used for teaching, patient education, device evaluation, and procedural planning. 3D printed models of patient-specific anatomy can be generated from 3D transesophageal, cardiac MRI, or cardiac computed tomographic datasets. This article discusses the potential advantages of 3D printing, reviews the different modalities to acquire a 3D dataset, and highlights the application of 3D printing to enhance patient screening and procedural planning in structural heart intervention.
View details for DOI 10.1016/j.iccl.2018.04.004
View details for PubMedID 29983152