Dr Prapa Kanagaratnam Consultant cardiologist

Background

Dr Prapa Kanagaratnam has been a consultant cardiologist at Imperial College Healthcare NHS Trust since 2005. He was educated at King Edward’s School, Birmingham and graduated with a medical degree from St Johns College, Cambridge, winning scholarships at both institutions. He joined Imperial College London in 1998 to undertake a PhD on a British Heart Foundation Junior Research Fellowship investigating the role of gap junctions in human atrial fibrillation. He was awarded the British Cardiac Society Young Investigator Prize for this work and obtained his PhD in 2002. He continued his research in the field of cardiac arrhythmias throughout his clinical cardiology training and secured further funding from the British Heart Foundation (BHF) and Wellcome Trust to supervise several PhDs. 

Dr Kanagaratnam was appointed consultant cardiologist at St Mary’s Hospital (now part of Imperial College Healthcare) and honorary senior lecturer at Imperial College London in 2005. He has supervised several students to both successful completion of their PhDs and winning national and international prizes and awards. 

His most important contribution to cardiac electrophysiology has been the development of Ripple Mapping, which is a novel method to visualise and understand cardiac activation in 3D. The technique was patented by Imperial Innovations and has been licensed by Biosense Webster Inc and incorporated within the CARTO3v4 system. It has been used in clinical studies to reveal novel arrhythmia mechanisms such as dual loop atrial tachycardias and slow ventricular scar channels. In addition to these mechanistic data the clinical benefits are being tested in multi-centre randomised studies.   

Dr Kanagaratnam was one of the early users of robotic ablation technology and has published the benefits and limitations of these approaches. This culminated in setting up the ERASE-VT study. There has been much speculation on the role of the autonomic nervous system in triggering and maintaining arrhythmias but there has been limited data to support intervention on autonomic ganglia in human arrhythmogenesis. Dr Kanagaratnam established a program of research which characterised the role of the left atrial autonomic nervous system in human atrial fibrillation. This has led to the testing of a new method for targeting the ganglionated plexi that trigger atrial fibrillation. If this proves to be effective it will have a revolutionary effect on thinking around atrial fibrillation. 

Dr Kanagaratnam’s latest innovation is a new method for understanding why electrical activation during atrial fibrillation can be transiently organised. He is also overseeing a research collaboration between clinicians and basic scientists using non-invasive mapping under autonomic strain to risk-stratify patients with inherited cardiac conditions. As clinical lead for cardiac electrophysiology, he has brought together a team of like-minded clinicians who recruit, follow research protocols and publish as a team. He has built relationships with Imperial Innovations and the protection of intellectual property has been the key to engaging the largest industry partners who have the resources to spread ideas globally. Working with the Imperial College Trials Unit has enabled him to validate that his clinical innovations translate into improved patient care. This has led to research partnerships with over 20 hospitals worldwide testing novel approaches to the treatment of arrhythmias.

Expertise

General cardiology, arrhythmias, atrial fibrillation, ablation therapy, pacemakers, ICDs, CRT devices, angiogram, ECHO, ECG

Research & publications

Bai, R.D.I., Biase, L., Valderrabano, M., Lorgat, F., Mlcochova, H., Tilz, R., Meyerfeldt, U., Hranitzky, P.M., Wazni, O., Kanagaratnam, P., Doshi, R.N., Gibson, D., Pisapia, A., Mohanty, P., Saliba, W., Ouyang, F., Kautzner, J., Gallinghouse, G.J. & Natale, A. (2012) Worldwide experience with the robotic navigation system in catheter ablation of atrial fibrillation: methodology, efficacy and safety. J Cardiovasc Electrophysiol, Aug, 23(8), 820-6

Hayat, S.A., Kojodjojo, P., Mason, A., Benfield, A., Wright, I., Whinnett, Z., Lim, P.B., Davies, D.W., Lefroy, D., Peters, N.S. & Kanagaratnam, P. (2013) Malfunction of subpectorally implanted cardiac resynchronization therapy defibrillators due to weakened header bond. J Cardiovasc Electrophysiol. Mar, 24(3), 351-5

Hunter, R.J., Jones, D.A., Boubertakh, R., Malcolme-Lawes, L.C., Kanagaratnam, P., Juli, C.F., Davies, D.W., Peters, N.S., Baker, V., Earley, M.J., Sporton, S., Davies, L.C., Westwood, M., Petersen, S.E. & Schilling, R.J. (2013) Diagnostic accuracy of cardiac magnetic resonance imaging in the detection and characterization of left atrial catheter ablation lesions: a multicenter experience. J Cardiovasc Electrophysiol, Apr, 24(4), 396-403

Jamil-Copley, S., Bokan, R., Kojodjojo, P., Qureshi, N., Koa-Wing, M., Hayat, S., Kyriacou, A., Sandler, B., Sohaib, A., Wright, I., Davies, D.W., Whinnett, Z., Peters, N., Kanagaratnam, P. & Lim, P.B. (2014) Noninvasive electrocardiographic mapping to guide ablation of outflow tract ventricular arrhythmias. Heart Rhythm., Apr, 11(4), 587-94  

Jamil-Copley, S. & Kanagaratnam, P. (2010) Stroke in atrial fibrillation--hope on the horizon? J R Soc Interface, Dec 6, 7 Suppl 6, S765-9

Jamil-Copley, S., Linton, N., Koa-Wing, M., Kojodjojo, P., Lim, P.B., Malcolme-Lawes, L., Whinnett, Z., Wright, I., Davies, W., Peters, N., Francis, D.P. & Kanagaratnam, P. (2013) Application of ripple mapping with an electroanatomic mapping system for diagnosis of atrial tachycardias. J Cardiovasc Electrophysiol. Dec, 24(12), 1361-9  

Jamil-Copley, S., Vergara, P., Carbucicchio, C., Linton, N.W.F., Koa-Wing, M., Luther, V., Francis, D.P., Peters, N.S., Davies, D.W.,  Tondo, C., Della Bella, P. & Kanagaratnam, P. (2015) Application of Ripple Mapping to visualise slow conduction channels within the infarct-related left ventricular scar. Circ Arrhythm Electrophysiol,  Feb;8(1), 76-86  

Jarman, J.W., Wong, T., Kojodjojo, P., Spohr, H., Davies, J.E., Roughton, M., Francis, D.P., Kanagaratnam, P., Markides, V., Davies, D.W. & Peters, N.S. (2012) Spatiotemporal behavior of high dominant frequency during paroxysmal and persistent atrial fibrillation in the human left atrium. Circ Arrhythm Electrophysiol, Aug 1, 5(4), 650-8

Jarman, J.W., Wong, T., Kojodjojo, P., Spohr, H., Davies, J.E., Roughton, M., Francis, D.P., Kanagaratnam, P., O'Neill, M.D., Markides, V., Davies, D.W. & Peters, N.S. (2014) Organizational index mapping to identify focal sources during persistent atrial fibrillation. J Cardiovasc Electrophysiol, Apr, 25(4), 355-63

Kojodjojo, P., O'Neill, M.D., Lim, P.B., Malcolm-Lawes, L., Whinnett, Z.I., Salukhe, T.V., Linton, N.W., Lefroy, D., Mason, A., Wright, I., Peters, N.S., Kanagaratnam, P. & Davies, D.W. (2010) Pulmonary venous isolation by antral ablation with a large cryoballoon for treatment of paroxysmal and persistent atrial fibrillation: medium-term outcomes and non-randomised comparison with pulmonary venous isolation by radiofrequency ablation. Heart, Sep, 96(17), 1379-84 

Kyriacou, A., Li Kam Wa, M.E., Pabari, P.A., Unsworth, B., Baruah, R., Willson, K., Peters, N.S., Kanagaratnam, P., Hughes, A.D., Mayet, J., Whinnett, Z.I. & Francis, D.P. (2013) A systematic approach to designing reliable VV optimization methodology: assessment of internal validity of echocardiographic, electrocardiographic and haemodynamic optimization of cardiac resynchronization therapy. Int J Cardiol, Aug 10, 167(3), 954-64 

Kyriacou, A., Pabari, P.A., Whinnett, Z.I., Arri, S., Willson, K., Baruah, R., Stegemann, B., Mayet, J., Kanagaratnam, P., Hughes, A.D. & Francis, D.P. (2012) Fully automatable, reproducible, noninvasive simple plethysmographic optimization: proof of concept and potential for implantability. Pacing Clin Electrophysiol, Aug;35(8), 948-60.   

Kyriacou, A., Pabari, P.A., Mayet, J., Peters, N.S., Davies, D.W., Lim, P.B., Lefroy, D., Hughes, A.D., Kanagaratnam, P., Francis, D.P. & Whinnett, Z.I. (2014) Cardiac resynchronization therapy and AV optimization increase myocardial oxygen consumption, but increase cardiac function more than proportionally. Int J Cardiol, Feb 1, 171(2), 144-52 

Kyriacou, A., Whinnett, Z.I., Sen, S., Pabari, P.A., Wright, I., Cornelussen, R., Lefroy, D., Davies, D.W., Peters, N.S., Kanagaratnam, P., Mayet, J., Hughes, A.D., Francis, D.P. & Davies, J.E. (2012) Improvement in coronary blood flow velocity with acute biventricular pacing is predominantly due to an increase in a diastolic backward-travelling decompression (suction) wave. Circulation, Sep 11, 126(11), 1334-44.   

Lewalter, T., Kanagaratnam, P., Schmidt, B., Rosenqvist, M., Nielsen-Kudsk, J.E., Ibrahim, R., Albers, B.A., Camm, A.J. (2014) Ischaemic stroke prevention in patients with atrial fibrillation and high bleeding risk: opportunities and challenges for percutaneous left atrial appendage occlusion. Europace, May, 16(5), 626-30  

Lim, P.B., Malcolme-Lawes, L.C., Stuber, T., Wright, I., Francis, D.P., Davies, D.W., Peters, N.S. & Kanagaratnam, P. (2011) Intrinsic cardiac autonomic stimulation induces pulmonary vein ectopy and triggers atrial fibrillation in humans. J Cardiovasc Electrophysiol, Jun;22(6):638-46  

Lim, P.B., Malcolme-Lawes, L.C., Stuber, T., Kojodjojo, P., Wright, I.J., Francis, D.P., Wyn Davies, D., Peters, N.S. & Kanagaratnam, P. (2011) Stimulation of the intrinsic cardiac autonomic nervous system results in a gradient of fibrillatory cycle length shortening across the atria during atrial fibrillation in humans. J Cardiovasc Electrophysiol, Nov, 22(11), 1224-31

Lim, P.B., Malcolme-Lawes, L.C., Stuber, T., Koa-Wing, M., Wright, I.J., Tillin, T., Sutton, R., Davies, D.W., Peters, N.S., Francis, D.P. & Kanagaratnam, P. (2011) Feasibility of multiple short, 40-s, intra-procedural ECG recordings to detect immediate changes in heart rate variability during catheter ablation for arrhythmias. J Interv Card Electrophysiol, Nov, 32(2), 163-71   

Linton, N.W., Koa-Wing, M., Francis, D.P., Kojodjojo, P., Lim, P.B., Salukhe, T.V., Whinnett, Z., Davies, D.W., Peters, N.S., O'Neill, M.D. & Kanagaratnam, P. (2009) Cardiac ripple mapping: a novel three-dimensional visualization method for use with electroanatomic mapping of cardiac arrhythmias. Heart Rhythm, Dec, 6(12), 1754-62

Malcolm-Lawes, L. & Kanagaratnam, P. (2010) Value of robotic navigation and ablation. Minerva Cardioangiol, Dec, 58(6), 691-9

Malcolme-Lawes, L.C., Lim, P.B., Wright, I., Kojodjojo, P., Koa-Wing, M., Jamil-Copley, S., Dehbi, H.M., Francis, D.P., Davies, D.W., Peters, N.S. & Kanagaratnam, P. (2013) Characterisation of the left atrial neural network and its impact on autonomic modification procedures. Circ Arrhythm Electrophysiol, Jun,6(3), 632-40  

Malcolme-Lawes, L.C., Juli, C., Karim, R., Bai, W., Quest, R., Lim, P.B., Jamil-Copley, S., Kojodjojo, P., Ariff, B., Davies, D.W., Rueckert, D., Francis, D.P., Hunter, R., Jones, D., Boubertakh, R., Petersen, S.E., Schilling, R., Kanagaratnam, P. & Peters, N.S. (2013) Automated analysis of atrial late gadolinium enhancement imaging that correlates with endocardial voltage and clinical outcomes: a 2-center study. Heart Rhythm, Aug, 10(8), 1184-91  

Malcolme-Lawes, L.C., Lim, P.B., Koa-Wing, M., Whinnett, Z.I., Jamil-Copley, S., Hayat, S., Francis, D.P., Kojodjojo, P., Davies, D.W., Peters, N.S. & Kanagaratnam, P. (2013) Robotic assistance and general anaesthesia improve catheter stability and increase signal attenuation during atrial fibrillation ablation. Europace, Jan,15(1), 41-7 

Meier, B. & Jai-Wun Park, J.W. (2015) Left atrial appendage occlusion for stroke prevention in atrial fibrillation: multicenter experience with the Amplatzer Cardiac Plug. EuroIntervention, Jan 22, 10(10)

Raphael, C., Kanagaratnam, P. & Francis, D.P. (2010) Further barriers to conversations about deactivation of implantable cardioverter-defibrillators. J Am Coll Cardiol, Feb 16, 55(7), 701-2   

Raphael, C.E., Koa-Wing, M., Stain, N., Wright, I., Francis, D.P. & Kanagaratnam, P. (2011) Implantable cardioverter-defibrillator recipient attitudes towards device deactivation: how much do patients want to know? Pacing Clin Electrophysiol, Dec, 34(12), 1628-33

Sacher, F., Wright, M., Tedrow, U.B., O'Neill, M.D., Jais, P., Hocini, M., Macdonald, R., Davies, D.W., Kanagaratnam, P., Derval, N., Epstein, L., Peters, N.S., Stevenson, W.G. & Haissaguerre, M., Wolff-Parkinson (2010) White ablation after a prior failure: a 7-year multicentre experience. Europace, Jun, 12(6), 835-41 

Thorning, C, Hamady, M., Liaw, J.V., Juli, C., Lim, P.B., Dhawan, R., Peters, N.S., Davies, D.W., Kanagaratnam, P., O'Neill, M.D. & Wright, A.R. (2011) CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation. Clin Imaging, Jan-Feb,35(1), 1-9   

Tzikas, A., Shakir, S., Gafoor, S., Omran, H., Berti, S., Santoro, G., Joelle Kefer, J., Landmesser, U., Nielsen-Kudsk, J.E., Cruz-Gonzalez, I., Sievert, H., Tichelbäcker, T., Kanagaratnam, P., Nietlispach, F., Aminian, A., Kasch, F., Freixa, X., Danna, P., Rezzaghi ,M., Vermeersch, P., Friederike Stock, F., Miroslava Stolcova, M., Marco Costa, M., Reda Ibrahim, R., Wolfgang Schillinger, W., Bernhard, Unsworth, B., Sutaria, N., Davies, D.W. & Kanagaratnam, P. (2011) Successful placement of left atrial appendage closure device is heavily dependent on 3-dimensional transesophageal imaging. J Am Coll Cardiol, Sep 13, 58(12), 1283

Whinnett, Z.I., Nott, G., Davies, J.E., Willson, K., Manisty, C.H., Kanagaratnam, P., Peters, N.S., Davies, D.W., Hughes, A.D., Mayet, J. & Francis, D.P. (2011) Maximizing Efficiency of Alternation Algorithms for Hemodynamic Optimization of the AV Delay of Cardiac Resynchronization Therapy. Pacing Clin Electrophysiol, Feb, 34(2), 217-25

Wright, I.J., Kojodjojo, P., Jamil-Copley, S., Davies, D.W., Stanbridge, R.D. & Kanagaratnam, P. (2013) Sustained tachycardia in a cardiac resynchronization therapy recipient: what is the mechanism of tachycardia? Pacing Clin Electrophysiol, Nov, 36(11), 1427-3  

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