Rajiv Mahajan

• MD, PhD
• Clinical Lead Cardiac Electrophysiolgy and Pacing at Lyell McEwin Hospital

Background The Adelaide Score is an artificial intelligence system that integrates objective vital signs and laboratory tests to predict likelihood of hospital discharge. Methods A prospective implementation trial was conducted at the Lyell McEwin Hospital in South Australia. The Adelaide Score was added to existing human, artificial intelligence,...

The electroanatomical characteristics of Septo Pulmonary Bundle

Epicardial macro-rentrant tachycardia involving the Septo-Pulmonary Bundle

Delineating the endo-epicardial connections of septo-pulmonary bundle as a cause of persistent posterior left atrial activation after single ring isolation

Blood pressure variability (BPV) impacts brain health by influencing brain structure and cerebrovascular pathologies, though the mechanisms are poorly understood. Changes in the cerebrovasculature may lead to late-onset depression, cognitive impairment, and dementia, however the relationship between BPV with depression and anxiety remains unclear,...

Defining the patterns, electrophysiological properties, and ablation strategies of endo-epicardial septo-pulmonary bundle.

Objectives Cardiac arrhythmias predict poor outcome after myocardial infarction (MI). We studied if arrhythmia monitoring with an insertable cardiac monitor (ICM) can improve treatment and outcome. Design BIO|GUARD-MI was a randomized, international open-label study with blinded outcome assessment. Setting Tertiary care facilities monitored the a...

Atrial fibrillation (AF) is associated with cognitive impairment, with or without history of stroke. The risk of developing cognitive impairment is increased after clinical stroke. Prospective registries confirm the increased risk of both vascular and Alzheimer’s dementia in patients with AF. The purported mechanistic links between AF and cognitive...

Background Mineralocorticoid receptor antagonists (MRAs) have emerged as potential therapy to target the underlying arrhythmogenic substrate in atrial fibrillation (AF). Nevertheless, there have been inconsistent results on the impact of MRAs on AF. Objective We sought to evaluate the effect of MRAs on AF incidence and progression in patients with...

Background Health literacy is a key enabler of effective behavioural modification in chronic diseases. While patient reported outcome measures (PROMs) exists for patient with atrial fibrillation (AF), none address risk factors comprehensively. The aim of the study was to develop and qualitatively validate a disease specific PROM that incorporates k...

Background The ACTIVE-AF study demonstrated that aerobic exercise prescription promotes the maintenance of sinus rhythm in patients with atrial fibrillation (AF). However, it is unclear whether these benefits are observed in patients with both paroxysmal and persistent AF. Purpose Compare efficacy of exercise intervention on arrhythmia recurrence...

Background Single-lead ECG devices may allow detection and diagnosis of cardiac rhythms. However, data on their accuracy for detecting cardiac arrhythmias beyond atrial fibrillation are limited. Objectives To determine the accuracy of the AliveCor KardiaMobile (AC; AliveCor Inc, Mountain View, CA) for the diagnosis of arrhythmias against gold stand...

The burden of SCAF in populations with end stage renal disease on dialysis and its implications are unclear. This meta-analysis was done to assess the prevalence of baseline clinical AF and SCAF in patients on haemodialysis and to study incremental benefit of screening for SCAF. After systematic literature search on PubMed, Scopus and Embase, five...

Background: Exercise training reduces recurrence of arrhythmia and symptom severity amongst patients with symptomatic, non-permanent atrial fibrillation. However, there is little evidence on whether this effect is modified by patient sex. Objectives: In a sub-analysis from the ACTIVE-AF randomised controlled trial (A Lifestyle-based, PhysiCal Ac...

Background: There is little evidence to guide the perioperative management of patients on a direct oral anticoagulant(DOAC) in the absence of a last known dose. Quantitative serum titers may be ordered but there is little evidence supporting this. Aims: This multi-center retrospective cohort study of consecutive surgical in-patients with a DOAC...

Background: There are limited data on the effect of exercise interventions on atrial fibrillation (AF) recurrence and symptoms. Objectives: The aim of this study was to determine the efficacy of an exercise and physical activity intervention on AF burden and symptoms among patients with symptomatic AF. Methods: This prospective, randomized con...

There is variability in treatment modalities for premature ventricular complexes (PVCs), including use of antiarrhythmic drug (AAD) therapy or catheter ablation (CA). This study reviewed evidence comparing CA vs AADs for the treatment of PVCs. A systematic review was performed from the Medline, Embase, and Cochrane Library databases, as well as the...

Background: Atrial fibrillation (AF) and heart failure (HF) portends a poor outcome. The HF universal definition has incorporated Heart Failure with mildly reduced Ejection Fraction (HFmrEF). We sought to evaluate the relationship between AF and different HF subtypes, with emphasis on HFmrEF. Methods: PubMed and Embase databases were searched up...

Introduction Atrial fibrillation (AF) is associated with increased risk of stroke, heart failure and death. Health literacy, an aspect that falls within precision health, has been recognised as an important factor. We will be focusing on the impact of these interventions specifically to AF and its health outcomes. Methods and analysis This protoco...

Introduction: Aerobic exercise prescription may promote maintenance of sinus rhythm in patients with atrial fibrillation (AF). Very little data exists on whether this may be modified by patient sex. Hypothesis: Male and female patients with AF would benefit from exercise prescription. Methods: This study was a prospective, randomized, controlled tr...

Objective: Heart rate reserve (HRR) is used to guide exercise training in patients with cardiovascular disease, primarily as a surrogate for oxygen uptake reserve (VO2R) as a marker of metabolic demand. However, the relationship between HRR and VO2R in patients with atrial fibrillation (AF) is not well described. We aimed to assess the validity of...

Background Atrial fibrillation (AF) has been shown to be both the cause and consequence of heart failure (HF) and signifies a poor outcome. The classification scheme for HF has evolved to recognize different underlying characteristics and clinical trajectory of HF subgroups Objective We conducted this meta-analysis to further evaluate the relations...

Introduction: Although single ring isolation is an accepted strategy for undertaking pulmonary vein (PV) and posterior wall isolation (PWI) during atrial fibrillation (AF) ablation, the learning curve associated with this technique as well as procedural and clinical success rates have not been widely reported. Methods and results: Prospectively...

Aims To systematic review and meta-analyse the association and mechanistic links between atrial fibrillation (AF) and cognitive impairment. Methods and results PubMed, EMBASE, and Cochrane Library were searched up to 27 March 2021 and yielded 4534 citations. After exclusions, 61 were analysed; 15 and 6 studies reported on the association of AF and...

Research links high blood pressure variability (BPV) with stroke and cerebrovascular disease, however, its association with cognition remains unclear. Moreover, it remains uncertain which BP-derived parameter (ie, variability or mean) holds more significance in understanding vascular contributions to cognitive impairment. We searched PubMed, Embase...

Introduction: Early clinical exposure as a part of vertical integration is an intervention that bridges the gap between the basic and clinical sciences. It can be achieved by exposing undergraduate medical students to clinical cases at an early stage. This study was conducted with an aim to introduce first professional MBBS students to clinical cas...

Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation (AF) is the most common clinically-relevant arrhythmia. Its initiation and maintenance is linked to the presence cardiovascular risk factors such as hypertension and obesity. Higher cardiorespiratory fitness (CRF) has been associated with a better prognosis. H...

Funding Acknowledgements Type of funding sources: None. Introduction Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1-2% of the global population, with the prevalence of AF increasing dramatically over the past two decades. Although low levels of cardiorespiratory fitness (CRF) and physical activity are predicti...

Introduction Successful pulmonary vein isolation (PVI) for atrial fibrillation (AF) depends on the formation of durable transmural lesions. Recently, novel indices have emerged to guide lesion delivery. The aim of the systematic review of literature was to determine AF recurrence following ablation guided by indices incorporating force, power and t...

Background The epidemiology of atrial fibrillation (AF) amongst Indigenous populations remains poorly characterised. We studied hospitalisations for AF in Central Australia, the most populous Indigenous region in the country. Methods Patients with a diagnosis of AF admitted to Alice Springs Hospital, the only secondary health care facility and pro...

Objectives: This study sought to evaluate the effect of weight loss on the atrial substrate for atrial fibrillation (AF). Background: Whether weight loss can reverse the atrial substrate of obesity is not known. Methods: Thirty sheep had sustained obesity induced by ad libitum calorie-dense diet over 72 weeks. Animals were randomized to 3 grou...

Background Anaemia frequently co‐exists with atrial fibrillation (AF) and has been variably associated with worse outcomes. We performed a systematic review and meta‐analysis to comprehensively assess the effect of anaemia on mortality, stroke/systemic thromboembolism and bleeding events in patients with AF. Methods MEDLINE and Embase were searche...

Objective To characterise contemporary pacemaker procedure trends. Methods Nationwide analysis of pacemaker procedures and costs between 2008–2017 in Australia. The main outcome measures were total, age‐ and gender‐specific implant, replacement and complication rates and costs. Results Pacemaker implants increased from 12,153 to 17,862. Implantat...

Obesity and metabolic syndrome are both associated with atrial fibrillation (AF). Recent research has revealed new insights into the effects of cardiac and noncardiac adipose tissue in mediating these associations. Cardiac adipose tissue, such as epicardial fat, is a powerful predictor of AF and leads to myocardial fatty infiltration and adipokine-...

Introduction: Early clinical exposure as a part of vertical integration is an intervention that bridges the gap between the basic and clinical sciences. It can be achieved by exposing undergraduate medical students to clinical cases at an early stage. This study was conducted with an aim to introduce first professional MBBS students to clinical cas...

Background Reduced exercise capacity and exercise intolerance are commonly reported by individuals with atrial fibrillation (AF). Our objectives were to evaluate the contributing factors to reduced exercise capacity and describe the association between subjective measures of exercise intolerance versus objective measures of exercise capacity. Meth...

Background: Anemia frequently co-exists with atrial fibrillation (AF). We performed a systematic review and meta-analyses to comprehensively assess the effect of anemia on stroke/systemic thromboembolism, bleeding, and mortality in patients with AF. Methods: MEDLINE and Embase were searched until May 2020. Cohort studies and secondary analyses of r...

Background Stroke is one of the most devastating complications of atrial fibrillation (AF) and is associated with poor patient outcomes. Recent registry data has demonstrated improved use of stroke prevention therapy with the advent of direct-acting oral anticoagulants, but little data exists in the Australian health care setting. Purpose To exami...

Background There is a growing burden of hospitalizations due to atrial fibrillation (AF). The implications of hospitalisation to the individual with AF has not been well characterized. Purpose To characterise the consequences of presenting to hospital with AF. Methods Individuals presenting to the emergency department (ED) of three hospitals in S...

Background: To evaluate the risk for ventricular arrhythmia (VA) and sudden cardiac death (SCD) in patients with cardiac sarcoidosis (CS) and determine the prognostic factors. Methods and results: PUBMED, EMBASE and SCOPUS were searched up to 14th April 2020. Studies reporting the incidence of SCD, appropriate ICD therapy in CS patients, or rele...

Objective To characterise the rate, causes and predictors of cessation of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF). Patients and methods Consecutive patients with AF with a long-term anticoagulation indication treated with NOACs (dabigatran, apixaban and rivaroxaban) in our centre from Septembe...

Objective Prior studies have demonstrated that anticoagulation underutilisation for atrial fibrillation (AF) and elevated stroke risk is common. However, there is little data on factors associated with appropriate anticoagulation, particularly in Indigenous Australians who face a disproportionate burden of AF and stroke. We thus sought to determine...

Introduction Amiodarone is a highly effective antiarrhythmic-drug with well recognized toxic side-effects. The effects of the drug late in patients with atrial fibrillation (AF) is not well described. Methods and results We present a single centre prospectively collected series of patients with thyrotoxicosis occurring late after the cessation of...

Background Ablation index (AI) and Lesion Size Index (LSI) are novel parameters that incorporates contact force, time, and power in a weighted formula. Recent studies have shown that such indices predict lesion size and durability of pulmonary vein isolation (PVI). However, the outcomes of ablation guided by indices of force-time-power, such as PV...

Funding Acknowledgements Dr Malik is supported by an Australian Postgraduate Award Scholarship from the University of Adelaide. OnBehalf Centre for Heart Rhythm Disorders, University of Adelaide & Royal Adelaide Hospital Background A bi-directional relationship exists between AF and the autonomic nervous system (ANS). Patients with AF studied in...

The COVID-19 pandemic poses a significant stress on health resources in Australia. The Heart Rhythm Council of the Cardiac Society of Australia and New Zealand aims to provide a framework for efficient resource utilisation balanced with competing risks when appropriately treating patients with cardiac arrhythmias. This document provides practical r...

Objective To examine the potential association of atrial fibrillation (AF) to syncope and falls, we undertook a systematic review and meta-analysis given the increasing prevalence of AF in older adults as well as emerging data that it is a risk factor for dementia. Patients and Methods CENTRAL, PubMed, and EMBASE databases were searched from incep...

Objective To undertake a systematic review and meta-analysis examining the impact of polypharmacy on health outcomes in atrial fibrillation (AF). Data sources PubMed and Embase databases were searched from inception until 31 July 2019. Studies including post hoc analyses of prospective randomised controlled trials or observational design that exam...

Aims: There is growing evidence that magnetic resonance imaging (MRI) scanning in patients with non-conditional cardiac implantable electronic devices (CIEDs) can be performed safely. Here, we aim to assess the safety of MRI in patients with non-conditional CIEDs. Methods and results: English scientific literature was searched using PubMed/Embas...

Background Research links blood pressure variability ( BPV ) with stroke; however, the association with cerebral small‐vessel disease ( CSVD ) remains unclear. As BPV and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding cerebrovascular morphological characteristics. Methods and Res...

Background Obesity is prevalent in Indigenous populations who exhibit significant differences in body fat composition. While excess regional adiposity can be partially inferred from clinical measurements, noninvasive imaging allows for direct quantification of specific fat depots. Epicardial fat is a visceral adipose tissue that has been strongly a...

Background: Studies have shown that suboptimal anticoagulation quality, as measured by time in therapeutic range (TTR), affects a significant percentage of patients with atrial fibrillation (AF). However, TTR has not been previously characterised in Indigenous Australians who experience a greater burden of AF and stroke. Method: Indigenous and n...

Background Obesity-mediated epicardial adipose tissue (EAT) expansion drives fat cell infiltration which forms the unique substrate for atrial fibrillation (AF). The LEGACY study showed the benefits of weight loss but an attenuated response with weight fluctuation. How fluxes in weight impacts the atrial substrate in not known. Objective To invest...

Background Sleep-disordered breathing (SDB) is an important risk factor for developing atrial fibrillation (AF), and treatment of concomitant SDB can improve AF rhythm outcomes. Diagnosis of SDB requires sleep studies which can pose a significant time and resource burden. We sought to develop a prediction score based on clinical characteristics tha...

Introduction Obesity and enhanced inflammatory response are two independent risk factors involved in the pathogenesis of atrial fibrillation (AF). Components of the NLRP3 inflammasome have been found to be expressed in cardiomyocytes and cardiac fibroblasts and that increased inflammasome activation contributes to the pathogenesis of AF. The NLRP3...

Background Implantation of implantable cardioverter defibrillator (ICD) is a Class IIb indication in patients with Cardiac Sarcoid and with LVEF 36%-49% despite immunosuppression and optimal heart failure therapy. Purpose This systematic review and meta-analysis aimed to provide an estimate on the incidence of ventricular arrhythmias and risk of s...

Background Fibrosis is a hallmark of atrial fibrillation (AF) substrate. Recent data suggests that fibrosis detected by late-gadolinium enhancement (LGE) cardiac MRI (CMR) can predict AF. However, this relationship is not well described. Objective To delineate the association of cardiac fibrosis detected by LGE CMR with AF prevalence, AF recurrenc...

Objective The aim of the meta-analysis was to determine the association of obesity and heart failure (HF) and the cardiac impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obese subjects. Methods MEDLINE, Embase and Web of Science were searched up to 3 April 2018. Studies reporting associ...

Objective: The aim of this study is to characterise hospitalisations due to atrial fibrillation (AF) compared with two other common cardiovascular conditions, myocardial infarction (MI) and heart failure (HF), in addition to the associated economic burden of these hospitalisations and contribution of AF-related procedures. Methods: The primary o...

Education has long been recognized as an important component of chronic condition management. Whereas education has been evaluated in atrial fibrillation (AF) populations as part of multifaceted interventions, it has never been tested as a single entity. The aim of this review is to describe the rationale for and role of education as part of compre...

The relationship between atrial fibrillation (AF) and thromboembolism is well established. AF confers a greater risk of stroke and systemic thromboembolism in affected patients, such that a third of all stroke events are due to AF. In addition, a significant proportion of embolic strokes of unexplained source are increasingly attributed to asymptom...

Abstract Background: Atrial arrhythmias are common in patients with implantable cardioverterdefibrillator (ICD). External shocks and internal cardioversion through commanded ICD shock for electrical cardioversion are used for rhythm-control. However, there is a paucity of data on efficacy of external versus internal cardioversion and on the risk o...

Background: Atrial fibrillation (AF) management guidelines recommend screening for symptoms of sleep-disordered breathing (SDB). We aimed to assess the role of self-reported daytime sleepiness in detection of patients with SDB and AF. Methods: A total of 442 consecutive ambulatory patients with AF who were considered candidates for rhythm contro...

Background: The posterior left atrium is an arrhythmogenic substrate that contributes to the initiation and maintenance of atrial fibrillation (AF); however, the feasibility, safety, and efficacy of posterior wall isolation (PWI) as an AF ablation strategy has not been widely reported. Methods: We undertook a systematic review and meta-analysis...