CARDIAC ARRHYTHMIAS: FROM GENES TO ELECTROPHYSIOLOGY AND RISK STRATIFICATION
Studied medicine in Pavlov Medical University (St. Petersburg, Russia) 1988-1994. During this time participated in one of the first student exchange programs between the Soviet Union and the USA spending two months at Strong Memorial Hospital, Rochester University School of Medicine. After graduation in 1994 was admitted to the Research Institute of Cardiology (now renamed to the Almazov Federal Heart, Blood and Endocrinology Centre) and from early years of professional carrier combined clinical work with research in electrophysiology.
Started PhD project at Lund University in 1997-1998, while working in Lund under supervision of Professor S Bertil Olsson and continued the research work as a guest researcher until the dissertation defence 2001. Has management experience from part-time employment at Evidence Clinical & Pharmaceutical Research, which was a contract research organisation that managed clinical trials in the former USSR since 1989. Left the company from the position of Vice President Medical Affairs in 2002 after relocation to Sweden.
Received Swedish medical license and cardiology certification 2004 and since then has been working in Arrhythmia Clinic as an electrophysiologist involved in both device surgery and catheter ablations. Since 2005 responsible for cardiogenetic service. In 2006 become an associate professor and in 2014 became an adjunct professor of cardiology at the Department of Cardiology, Lund University
Member of the International Council on Electrocardiology and member of the Board of Trustees of the International Society for Holter and Noninvasive Electrocardiology (ISHNE). Editorial Board member at the Journal of Electrocardiology and Asdociate Editor at the Annals of Noninvasive Electrocardiology.
July 2016 was awarded Fulbright Commission Visiting Scholar grant and moved to the USA in order to pursue research in electrocardiology and cardiogenetics at the University of Rochester, NY until June 2017.
Author of 115 original publications and 32 reviews (2016-12-14). An updated publication list can be retrieved from PubMed.com
Research directions and selected publications:
Since doctoral thesis defence in 2001 (”The role of impaired interatrial conduction in paroxysmal atrial fibrillation: From anatomy to electrophysiology”), atrial fibrillation has been a corner stone of the research program that covers a range of topics:
Atrial anatomy and structural substrate of atrial fibrillation
- Substrates for intra- and interatrial conduction in the atrial septum: Anatomical study on 84 human hearts. Heart Rhythm 2008;5(8):1189-1195
- Structural abnormalities in atrial walls are associated with the presence and persistency of atrial fibrillation but not with age. J Am Coll Cardiol 2011;58(21):2225-32
Genetics of atrial fibrillation
- Genetic polymorphisms for estimating risk of atrial fibrillation in the general population. Arch Intern Med 2012;172(9):742-4.
- Genetic polymorphisms confer risk of atrial fibrillation in patients with heart failure: a population-based study. Eur J Heart Failure. 2013;15(3):250-7
Atrial fibrillation and stroke
- Electrocardiographic and echocardiographic predictors of paroxysmal atrial fibrillation detected after ischemic stroke. BMC Cardiovasc Disorders. 2016;16(1):209
- Predictors of new onset atrial fibrillation during 10-year follow-up after first-ever ischemic stroke. Int J Cardiol. 2015 Jul 14;199:248-252.
- Atrial fibrillation in the Swedish national patient registries: How much do we miss? Europace. 2014;16(12):1714-9.
ECG-based diagnostic tools development and validation
P-wave signal-averaged ECG
- P-wave morphology: underlying mechanisms and clinical implications. Ann Noninvasive Electrocardiol 2012;17(3):161-9
- Interatrial conduction can be accurately determined using a standard 12-lead ECG - Validation of P wave morphology using electroanatomical mapping in human. Heart Rhythm 2008;5(3):413-8
- Non-invasive evidence of shortened atrial refractoriness during sinus rhythm in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2009;32:302-7
- Abnormal P-wave morphology is a predictor of atrial fibrillation development and cardiac death in MADIT II patients. Ann Noninvasive Electrocardiol 2010;15(1):63-72.
- Abnormal atrial activation in young patients with lone atrial fibrillation. Europace 2011;13:188-192
Non-invasive assessment of atrial fibrillatory activity
- Atrial fibrillatory rate in the clinical context: Natural course and prediction of intervention outcome. Europace. 2014;16 Suppl 4:iv110-iv119
- Clinical variables associated with procedural termination and long-term clinical outcome of catheter ablation for chronic atrial fibrillation. J Am Coll Cardiol. 2009;54(9):788-95
- Low atrial fibrillatory rate is associated with poor outcome in patients with mild to moderate heart failure. Circulation Arrhythmia Electrophysiol. 2012;5:77-83
- Analysis of atrial fibrillatory rate during spontaneous episodes of atrial fibrillation in humans using implantable loop recorder ECG. J Electrocardiol. 2012; 45(6):723-6
Low atrial fibrillatory rate is associated with spontaneous conversion of recent-onset atrial fibrillation.
Apart from the atrial fibrillation related topics, the research program has now expanded to cover broader topics of electrocardiology:
Prevention of sudden death; improving risk stratification
This line of research is based on a combination of retrospective and prospective studies on patients who received implantable cardioverter-defibrillators with or without cardiac resynchronisation function for prevention of sudden death due to ischemic or non-ischemic congestive heart failure. The main research objective is identification of imaging- and ECG-based predictors of therapeutic efficacy and increased risk in order to optimize the choice of treatment.
- Predictors of ventricular fibrillation at reperfusion in patients with acute ST-elevation myocardial infarction treated by primary percutaneous coronary intervention. Am J Cardiol. 2015;115(4):417-22.
- Prognostic impact of early ventricular fibrillation in patients with ST-elevation myocardial infarction treated with primary PCI.. Eur Heart J Acute Cardiovascular Care 2012;1(4):302-311
Electrocardiography in acute coronary syndrome
Morphological correlates of dynamic ECG changes caused by myocardial ischemia are studied in two PhD projects that include clinical studies, animal experiments and analysis of large-scale trial data collected in international collaboration.
- Evaluation of depolarization changes during acute myocardial ischemia by analysis of QRS slopes. J Electrocardiol 2011 Jul-Aug;44(4):416-24
- ST-segment dynamics during reperfusion period and the size of myocardial injury in experimental myocardial infarction. J Electrocardiol 2011;44(1):74-81
- Transit and rapid QRS widening associated with J-wave pattern predicts impending ventricular fibrillation in experimental myocardial infarction. Heart Rhythm. 2014 11(7):1195-201
Inherited cardiac diseases
Risk stratification of patients with inherited cardiac diseases associated with high risk of sudden death is an objective of the ongoing research that includes establishing of a structured follow-up service and register-based studies, such as the Nordic Arrhythmogenic Cardiomyopathy Registry, in which I participate as a Steering Committee member and has a responsibility for coordinating Swedish sites. First publications based on the registry data provided first comprehensive report on the diagnostic accuracy of cardiac ultrasound in relation to cardiac magnetic resonance imaging in the context of ARVC and assessed interobserver variability in detection of epsilon waves, a pathognomonic sign of ARVC that appeared to demonstrate unacceptably high variability in interpretation that may lead to overdiagnosis of the disease:
- The diagnostic performance of imaging methods in ARVC using the 2010 Task Force criteria. Eur Heart J Cardiovasc Imaging. 2014;15(11):1219-25
- High interobserver variability in the assessment of epsilon waves: implications for diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Heart Rhythm. 2016 Jan;13(1):208-16