Arrhythmias & Electrophysiology

Cardiac electrophysiology and arrhythmia research at St George’s has a long-standing reputation for excellence.

It has been led for many years by Professor A John Camm with Dr Elijah R Behr, Professor Sanjay Sharma, Professor Marek Malik and Dr Velislav Batchvarov. Added to this are strong academic interests from Honorary Senior Lecturers Dr Mark Gallagher and Dr Magdi Saba.

The focuses are on sudden death, ventricular arrhythmias and atrial fibrillation with a translational approach studying genetics, proteomics, pathology, epidemiology, electrocardiology, drug therapies and interventional techniques.

There is synergistic collaboration across the department with Professor Kausik Ray, Dr Ranjan Sharma, Dr Nick Bunce and Dr Lisa Anderson with the Basic Medical Sciences Division.

The research interests in this group are as follows:

  • Sudden Arrhythmic Death Syndrome (SADS)
  • Monogenic arrhythmic syndromes and cardiomyopathies
  • Clinical non-invasive and invasive investigation of atrial fibrillation
  • Ventricular and ischaemic heart disease
  • Novel drug therapies in atrial fibrillation
  • Interventional studies of ventricular arrhythmia research

Within the Arrhythmias & Cardiomyopathy research group we focus on epidemiology, electrocardiology, pathology and genetics of sudden death in various groups, including:

  • The general population;
  • Athletes;
  • Young people; and
  • Sudden Arrhythmic Death Syndrome (SADS).

We also focus on:

  • Clinical and genetic investigation of monogenic arrhythmia syndromes and cardiomyopathies and the acquired long QT syndrome due to medications;
  • Novel gene discovery and genetic modifiers of phenotype in monogenic arrhythmia syndromes;
  • Clinical non-invasive investigation of atrial fibrillation, ventricular and ischaemic heart disease;
  • Major studies of intervention and novel drug therapies in atrial fibrillation;
  • Proteomic and functional investigation of atrial fibrillation and heart failure; and
  • Interventional studies of ventricular arrhythmia research.
Prof A John CammBHF Professor of Clinical Cardiology
Dr Ranjan SharmaConsultant Cardiologist, Director of Echocardiography at St Georges
Magdi M SabaConsultant, Cardiac Electrophysiology
Dr Elijah BehrReader in Cardiovascular Medicine
Prof Marek MalikProfessor of Cardiac Electrophysiology
Prof Sanjay SharmaProfessor of Inherited Cardiac Diseases and Sports Cardiology
Velislav Nikolaev BatchvarovSenior Research Fellow
Dr Ayesha De Souza Senior Research Fellow
Dr Yanushi Dullewe WijeyeratneNIHR Academic Clinical Fellow in Cardiology
Dr. Mark GallagherConsultant Cardiologist / Electrophysiologist, Clinical lead in Electrophysiology, Clinical Director of Cardiovascular

The objectives of the Arrhythmias & Cardiomyopathy research group is to develop novel methods for improving and refining the stratification of risk of sudden death in inherited and acquired cardiac disease and in the general population, utilising clinical and molecular markers.

We also aim to translate these novel risk markers into tools to personalise medical management, and develop novel clinical and genetic diagnostic methods in the inherited heart diseases. Our research will ultimately result in the emergence of novel approaches towards intervention and drug therapies for arrhythmias in inherited and acquired heart disease.

We also aim to evaluate the role of ECG for screening in the prevention of sudden death in the general population and sports people, and evaluate the value of ECG markers of sudden death in patients following myocardial infarction, with cardiomyopathy or heart failure in orer to implement effective therapy with the implantable cardioverter defibrillator.

Another objective is to evaluate the effect of cardiac and non-cardiac drug therapy with regard to it's effect on sudden and all cause cardiovascular death, investigate the risk for patients with atrial fibrillation and to demonstrate appropriate therapy to reduce that risk.

Research into SADs at St George's University of London has contributed directly to the development of the patient pathways and standards required of the assessment of families with SADS deaths and inherited heart disease.

Furthermore, research into drug-induced arrhythmia will be a first step of pharmacogenomic personalisation of drug therapy to reduce the risk of sudden death due to medication.

Epidemiological studies: the ICAP clinic, funded and run by Cardiac Risk in the Young will study 14-year-olds prospectively over five years in the South East of England to establish the potential benefit of ECG screening to prevent sudden death (Professor Sanjay Sharma).

Pathology and Molecular Autopsy of SADS and Sudden Infant Death Syndrome (SIDS): Investigation of the pathology, genetics and implications of the autopsy in sudden death in the young focusing on SADS and SIDS (Dr Elijah Behr, Professor Sanjay Sharma)

Genetic studies of monogenic disease: Novel gene discovery and genetic modifiers of phenotype (Dr Elijah Behr and SGUL collaborators: Dr Jamshidi, Professor Crosby and Professor Jeffery (Basic Medical Sciences) and Dr Bevan (Neurosicences)).

Genetic studies of the acquired long QT syndrome: The Drug-Induced Arrhythmia Risk Evaluation (DARE) study (Dr Elijah Behr, Professor A John Camm and SGUL collaborators: Dr Jamshidi, Dr Bevan and Professor Jeffery).

Genetic studies of the general population: Genetics in relation to cardiac screening, ECG parameters and sudden death risk (Dr Elijah Behr, Professor Sanjay Sharma and Dr Jamshidi).

Clinical non-invasive studies: Novel electrocardiography, echocardiography and electrophysiological studies in arrhythmia syndromes, cardiomyopathies, drug-induced arrhythmia, atrial fibrillation and ischaemic heart disease. (Dr Elijah Behr, Professor A John Camm, Dr Batchvarov, Dr Kiotsekoglou, Dr Anderson, Dr Sharma, Dr Saba and Dr Gallagher)

Clinical invasive studies: Patients with monogenic diseases and ventricular arrhythmias of various causes (Dr Elijah Behr and Dr Magdi Saba) as well as atrial fibrillation (Dr Elijah Behr and Dr Mark Gallagher).

Major translational and interventional studies in atrial fibrillation research: the EAST and EUTRAF studies with SGUL as the principal investigator (Professor A  John Camm).

Novel drug therapies in atrial fibrillation (Professor John Camm).

Proteomic and functional investigation of atrial fibrillation and heart failure (Professor John Camm and Dr Ayesha De Souza).

Raju H, Papadakis M, Govindan M, Bastiaenen R, Chandra N, O'Sullivan A, Baines G, Sharma S, Behr ER. Low prevalence of risk markers in cases of sudden death due to Brugada syndrome relevance to risk stratification in Brugada syndrome. J Am Coll Cardiol 2011; 57(23):2340-5.

Behr ER, Dalageorgou C, Christiansen M, Syrris P, Hughes S, Tome Esteban MT, Rowland E, Jeffery S, McKenna WJ. Sudden arrhythmic death syndrome: familial evaluation identifies inheritable heart disease in the majority of families. Eur Heart J 2008; 29(13):1670-80.

Makita N, Behr E, Shimizu W, Horie M, Sunami A, Crotti L, Schulze-Bahr E, Fukuhara S, Mochizuki N, Makiyama T, Itoh H, Christiansen M, McKeown P, Miyamoto K, Kamakura S, Tsutsui H, Schwartz PJ, George AL Jr, Roden DM. The E1784K mutation in SCN5A is associated with mixed clinical phenotype of type 3 long QT syndrome. J Clin Invest 2008; 118(6):2219-29.

Behr ER, Casey A, Sheppard M, Wright M, Bowker TJ, Davies MJ, McKenna WJ, Wood DA. Sudden arrhythmic death syndrome: a national survey of sudden unexplained cardiac death. Heart 2007; 93(5):601-5.

Behr E, Wood DA, Wright M, Syrris P, Sheppard MN, Casey A, Davies MJ, McKenna W; Sudden Arrhythmic Death Syndrome Steering Group. Cardiological assessment of first-degree relatives in sudden arrhythmic death syndrome. Lancet 2003; 362(9394):1457-9.

 

Drug Induced Arrhythmia Risk Evaluation (DARE) Study: BHF Special Project grant

ARITMO project – the Arrhythmogenic Potential of Drugs: 3 year European Union FP7 grant

Next Generation Sequencing in Inherited Heart Disease: BHF Special Project Grant