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Electrophysiology Research Overview

All CCEP fellows are required to participate in meaningful research during their training. In the early stages of training the fellows will identify a research mentor, preferably among our extensive CCEP faculty or other clinical faculty in the Cardiology division. This is critically important for the CCEP fellows who intend to pursue a career in academics. The research experience chosen by the CCEP fellow may be in clinical research or basic electrophysiology. At UCSD the CCEP program has numerous ongoing clinical research projects, some of which are multicenter trials, but many of which are investigator originated. This program is known for developing new treatment approaches for cardiac arrhythmias, particularly in the areas of catheter ablation techniques, external beam radio-therapy ablation and CIED therapy, for performing meta-analyses and large database analyses on clinically relevant subjects, and for developing new catheter ablation devices, mapping systems, and acting as an early testing site for novel industry developed diagnostic and therapeutic devices and anti-arrhythmic drugs. These extensive research opportunities provide the CCEP fellow with ample opportunity to participate in innovative clinical research. In addition, this CCEP program collaborates with engineering and basic cellular arrhythmia research laboratories on the University campus, from which research studies are frequently published, providing an opportunity for the CCEP fellow to participate in basic or translational research. All CCEP program faculty have had extensive experience conducting clinical research at UCSD, including interacting with the UCSD Human Subjects Protection (IRB) Committee, thus giving program faculty the necessary experience to educate the CCEP fellows in all aspects of research study development, protocol submission, informed consent, moral and ethical considerations, study performance, interaction with industry sponsors, data analysis, manuscript preparation and submission.

 

Areas of Electrophysiology Research at UC San Diego

EP Clinical Outcomes and Registries Research Group

The UCSD EP faculty have become nationally and internationally recognized for both developing and working with clinical registries to report outcomes in arrhythmia care.  Previous fellowship projects have included both National (NCDR, ICD Registry, PINNACLE Registry, etc) and UCSD databases (UC San Diego AF Ablation Registry, UC San Diego PVC/VT, and UC San Diego CTEPH Registries). Other projects have investigated mechanisms of arrhythmias and novel treatment approaches that include medical and procedural outcomes.

Ventricular Arrhythmias (VT/VF)  and Sudden Cardiac Death Research Group

The Ventricular Arrhythmia and Sudden Death Research Group investigates the mechanisms arrhythmia initiation and maintenance, targeted therapies for ventricular arrhythmias, imaging technologies, and ventricular arrhythmia risk prediction. Current fellowship projects include investigating the mechanisms of ventricular fibrillation, the role of ablation in ventricular fibrillation, computed tomography in ventricular arrhythmia risk stratification, and developing tools and algorithms for prediction of sudden cardiac death using invasive and non-invasive modalities.

Lead Extraction Research Group

UCSD has been an international leader in extractions for more than a decade with close to 1000 lead extractions performed. Fellows have very successfully utilized the extensive UCSD Extraction Database to present abstracts at national meetings, publish papers and contribute book chapters in major lead extraction publications. An ongoing collaboration with UCSD Radiology and Advanced Imaging has led to several recent publications in the area of imaging and risk stratification for lead extraction.

Advanced Cardiac Imaging Research Group

There are active collaborations between our group and the UCSD Departments of Bioengineering and Radiology to develop techniques using advanced cardiac imaging (CT and MRI) to study arrhythmia mechanisms and develop tools to help guide arrhythmia therapy.

Non-invasive Radioablation of Arrhythmias Research Group

With strong collaborations with the UCSD Departments of Radiation Medicine, Radiology and Bioengineering, the UCSD electrophysiology group has performed non-invasive stereotactic ablative body radiotherapy to treat refractory arrhythmias. Active research projects are underway to evaluate and improve this novel therapy.

 

Selected Research Publications by Electrophysiology Fellows

Vanam S, Darden D, Munir MB, Aldaas O, Hsu JC, Han FT, Hoffmayer KS, Raissi F, Birgersdotter-Green U, Feld GK, Krummen DE, Ho G. Characteristics and outcomes of recurrent atrial fibrillation after prior failed pulmonary vein isolation. J Interv Card Electrophysiol. 2022 Feb 16.

Darden D, Duong T, Du C, Munir MB, Han FT, Reeves RR, Saw J, Zeitler EP, Al-Khatib SM, Russo AM, Minges AE, Curtis JP, Freeman JV, Hsu JC. Sex Differences in Procedural Outcomes with Left Atrial Appendage Occlusion: Insights from the NCDR LAAO Registry. JAMA Cardiol. 2021 Aug 11:e213021.

Darden D, Aldaas O, Malladi CL, Mylavarapu PS, Munir MB, Han FT, Hoffmayer KS, Raissi F, Ho G, Krummen D, Feld GK, Hsu JC. Association between early recurrences of atrial tachyarrhythmias and long-term outcomes in patients after repeat atrial fibrillation ablation. J Interv Card Electrophysiol. 2021 Apr 7.

Darden D, Hsu JC, Tzou W, von Alvensleben JC, Brooks M, Hoffmayer KS, Brambatti M, Sauer W, Feld GK, Adler E. Fasciculoventricular and Atrioventricular Accessory Pathways in Patients with Danon Disease and Preexcitation: A Multicenter Experience. Heart Rhythm. 2021 Mar 15:S1547-5271(21)00235-6.

Darden D, Aldaas O, Malladi CL, Mylavarapu PS, Munir MB, Han FT, Hoffmayer KS, Raissi F, Ho G, Krummen D, Feld GK, Hsu JC. Association between early recurrences of atrial tachyarrhythmias and long-term outcomes in patients after repeat atrial fibrillation ablation. J Interv Card Electrophysiol. 2021 Apr 7. doi: 10.1007/s10840-021-00987-z. Epub ahead of print. [Cited in Pubmed, PMID: 33826085]

Munir MB, Birgersdotter-Green U. Low-temperature electrocautery for secondary cardiac implantable electronic device implantation: Are we ready for their routine clinical application? Heart Rhythm. 2021 Apr 8:S1547-5271(21)00321-0. doi: 10.1016/j.hrthm.2021.03.045. Epub ahead of print. [Cited in Pubmed, PMID: 33839328]

Asad ZUA, Akhtar KH, Jafry AH, Khan MH, Khan MS, Munir MB, Lakkireddy DR, Gopinathannair R. Uninterrupted versus interrupted direct oral anticoagulation for catheter ablation of atrial fibrillation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol. 2021 Apr 16. doi: 10.1111/jce.15043. Epub ahead of print. [Cited in Pubmed, PMID: 33861494]

Khan MZ, Munir MB (equal contribution), Darden D, Pasupula DK, Balla S, Han FT, Reeves R, Hsu JC. Racial Disparities In In-hospital Adverse Events Among Patients with Atrial Fibrillation Implanted with a Watchman Left Atrial Appendage Occlusion Device: A United States National Perspective. Circ Arrhythm Electrophysiol. 2021 Apr 28. doi:10.1161/CIRCEP.120.009691. Epub ahead of print. [Cited in Pubmed, PMID: 33909473]

Munir MB, Khan MZ, Darden D, Pasupula DK, Balla S, Han FT, Reeves R, Hsu JC. Pericardial effusion requiring intervention in patients undergoing percutaneous left atrial appendage occlusion: Prevalence, predictors, and associated in-hospital adverse events from 17,700 procedures in the United States. Heart Rhythm. 2021 Sep;18(9):1508-1515. doi: 10.1016/j.hrthm.2021.05.017. Epub 2021 May 18. PMID: 34020049

Darden D, Duong T, Du C, Munir MB, Han FT, Reeves R, Saw J, Zeitler EP, Al-Khatib SM, Russo AM, Minges KE, Curtis JP, Freeman JV, Hsu JC. Sex Differences in Procedural Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion: Insights From the NCDR LAAO Registry. JAMA Cardiol. 2021 Nov 1;6(11):1275-1284. doi: 10.1001/jamacardio.2021.3021. Erratum in: JAMA Cardiol. 2021 Oct 20;: PMID: 34379072

Pasupula DK, Munir MB, Bhat AG, Siddappa Malleshappa SK, Meera SJ, Spooner M, Koranne K, Olshansky B, Hirji S, Hsu JC. Outcomes and predictors of readmission after implantation of a percutaneous left atrial appendage occlusion device in the United States: A propensity score-matched analysis from The National Readmission Database. J Cardiovasc Electrophysiol. 2021 Nov;32(11):2961-2970. doi: 10.1111/jce.15247. Epub 2021 Sep 21. PMID: 34535939

Patel K, Natale A, Yang R, Trivedi C, Romero J, Briceno D, Mohanty S, Alviz I, Natale V, Sanchez J, Della Rocca DG, Tarantino N, Zhang XD, Mohanty P, Horton R, Burkhardt D, Gopinathannair R, Gallinghouse GJ, Lakkireddy D, Di Biase L. Is transesophageal echocardiography necessary in patients undergoing ablation of atrial fibrillation on an uninterrupted direct oral anticoagulant regimen? Results from a prospective multicenter registry. Heart Rhythm. 2020 Dec; 17 (12): 2093-2099.

Romero J, Gabr M, Patel K, Briceno D, Diaz JC, Alviz I, Trivedi C, Mohanty S, Della Rocca DG, Lakkireddy D, Natale A, Di Biase L. Left atrial appendage electrical isolation for non-paroxysmal atrial fibrillation: a systematic review and meta-analysis. Europace. 2021 Feb 5; 23 (2): 226-237.

Di Biase L, Romero J, Du X, Mohanty S, Trivedi C, Della Rocca DG, Patel K, Sanchez J, Yang R, Alviz I, Mohanty P, Gianni C, Tarantino N, Zhang XD, Horton R, Al-Ahmad A, Lakkireddy D, Burkhardt D, Chen M, Natale A. Catheter Ablation of Ventricular Tachycardia in Ischemic Cardiomyopathy: Impact of Concomitant Amidoarone Therapy on Short and Long-Term Clinical Outcomes. Heart Rhythm. 2021 Feb 13; S1547- 5271(21)00132-6.

Lupercio F, Giancaterino S, Villablanca PA, Han F, Hoffmayer K, Ho G, Raissi F, Krummen D, Birgersdotter-Green U, Feld G, Reeves R, Mahmud E, Hsu JC. P2Y12 inhibitors with oral anticoagulation for percutaneous coronary intervention with atrial fibrillation: a systematic review and meta-analysis.
Heart. 2020 Apr;106(8):575-583. doi: 10.1136/heartjnl-2019-315963. Epub 2020 Feb 7.

Hsu JC, Lupercio F. Left Atrial Appendage Triggers in Atrial Fibrillation: How Often Are They the Source? JACC Clin Electrophysiol. 2020 Jan;6(1):31-33. doi: 10.1016/j.jacep.2019.10.007. PMID: 31971903

Lupercio F, Lin AY, Aldaas OM, Romero J, Briceno D, Hoffmayer KS, Han FT, Di Biase L, Feld GK, Hsu
JC. Role of adjunctive posterior wall isolation in patients undergoing atrial fibrillation ablation: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2020 Jun;58(1):77-86. doi: 10.1007/s10840-019-00634-8. Epub 2019 Oct 31. PMID: 31673901

Eskander MA, Adler E, Hoffmayer KS. Arrhythmias and sudden cardiac death in post-cardiac transplant patients. Curr Opin Cardiol. 2020 May;35(3):308-311. doi: 10.1097/HCO.0000000000000731. PMID: 32109927