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Joseph Akar, MD, PhD

Professor of Medicine (Cardiovascular Medicine)
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Additional Titles

Director, Cardiac Electrophysiology Program, Internal Medicine

Director, Complex Ablation Program

About

Titles

Professor of Medicine (Cardiovascular Medicine)

Director, Cardiac Electrophysiology Program, Internal Medicine; Director, Complex Ablation Program

Biography

I am the Chief of Cardiac Electrophysiology and Professor at the Yale School of Medicine. I completed Internal Medicine residency at the Yale New Haven Hospital, followed by fellowships in Cardiovascular Medicine and Cardiac Electrophysiology at the University of Virginia, where I also obtained a PhD in Molecular Physiology and Biological Physics. Subsequently I joined Loyola University Medical Center in Chicago where I was on faculty for 5 years before returning to Yale to establish and direct the Complex Ablation Program.

I specialize in catheter ablation of complex arrhythmias such as refractory persistent atrial fibrillation, ventricular tachycardia, and arrhythmias related to heart failure and valve disease. I have expertise in performing ablation without fluoroscopy in order to reduce patient exposure to radiation. I implant a wide range of cardiac devices, and I have a particular interest in device remote monitoring. I have published extensively in these areas and am a member of multiple guideline committees. I have received research funding from the National Institutes of Health, the American College of Cardiology, and the Food and Drug Administration.

Appointments

Other Departments & Organizations

Education & Training

Fellow
University of Virginia (2004)
PhD
University of Virginia (2004)
Fellow
University of Virginia (2002)
Resident
Yale-New Haven Hospital (1998)
MD
University of Pittsburgh (1995)

Research

Overview

I take a systems biology approach to the study of AF, from the cellular to the population science level.

1. Basic Mechanisms of Atrial Fibrillation. A major focus of pre-clinical and clinical research interest is the study of electrical and structural remodeling processes that lead to the development of AF. This has been a major theme of my academic work over the past two decades. During my fellowship training at the University of Virginia I pursued a PhD in Molecular Physiology and Biological Physics, focusing on the just recently described phenomena of electrical and structural remodeling in AF. I used animal models of AF to examine changes in the mitochondrial and subcellular distribution of different elements (Na, K, Cl, Mg) during the development of electrical remodeling. I also determined the relative contribution of atrial electrical and structural remodeling to the spatiotemporal organization of AF. I am currently the co-PI of an extramural NIH R01 grant performing non-invasive molecular imaging of activated matrix metalloproteinases as a substrate for the development of atrial structural remodeling and the precursor of fibrosis. The grant aims at developing novel techniques for early non-invasive assessment of AF vulnerability. This holds the potential for early detection and treatment of the disease before the onset of fibrosis. I have been collaborating with Dr. Lawrence Young and Dr. Fadi Akar to study the mouse model of AF induced by LKB1 deletion. My expertise in atrial remodeling has provided the opportunity to be a writing group member of the 2016 EHRA/HRS Consensus Statement on Atrial Cardiomyopathy.

a. Akar JG, Everett TH, Kok LC, Moorman JR, Haines DE. Effect of electrical and structural remodeling on spatiotemporal organization in acute and persistent atrial fibrillation. J Cardiovasc Electrophysiol 2002; 13:1027-1034.

b. Akar JG, Everett TH, Ho RH, Craft J, Haines DE, Somlyo AP, Somlyo AV. Intracellular chloride accumulation and subcellular elemental distribution during atrial fibrillation. Circulation 2003; 107:1810-1815.

c. Mukherjee R, Akar JG, Wharton JM, Adams DK, McClure CD, Stroud RE, Rice AD, Desantis SM, Spinale FG, Gold MR. Plasma profiles of matrix metalloproteinases and tissue inhibitors of the metalloproteinases predict recurrence of atrial fibrillation following cardioversion. J Cardiovasc Transl Res. 2013; 6:528-35.

d. Kim GE, Ross JL, Xie C, Su KN, Zaha VG, Wu X, Palmeri M, Ashraf M, Akar JG, Russell KS, Akar FG, Young LH. LKB1 deletion causes early changes in atrial channel expression and electrophysiology prior to atrial fibrillation. Cardiovasc Res 2015; 108:197-208.

2. Dynamics of Atrial Fibrillation. I have a long-standing interest in using signal analysis techniques to identify mechanisms and quantify spatiotemporal organization of AF. Given the clinical importance of objectively measuring the level of AF electrogram fractionation, I worked closely with biomedical engineers to use signal analysis techniques (Fourier transforms, entropy, cross correlations and wavelet analysis) to quantify AF organization in time and space. More recently, I have turned my attention to using the non-linear dynamics methodology of Recurrence Quantitative Analysis (RQA) to examine basic pathophysiological mechanisms of AF. Using computer modeling I am applying RQA in silico to differentiate differentiate different AF mechanisms (i.e spiral wave reentry “rotors” versus multiple wavelet reentry), and subsequently applying the RQA analysis on human AF signals obtained at the time of ablation.

a. Everett TH, Moorman JR, Kok LC, Akar JG, Haines DE. Assessment of global atrial fibrillation organization to optimize the timing of atrial defibrillation. Circulation 2001; 103:2857-2861.

b. Everett TH, Akar JG, Kok LC, Moorman JR, Haines DE. Use of global atrial fibrillation organization to optimize the success of burst pace termination. J Am Coll Cardiol 2002; 40:1831-1840.

c. Webber Jr. CL, Hu Z, Akar JG. Unstable Cardiac Singularities May Lead to Atrial Fibrillation. Int J Bifurc Chaos. 2011; 21: 1141–1151.

d. Hummel JP, Baher A, Buck B, Fanarjian M, Webber CL, Akar JG. A Method for Quantifying Recurrent Patterns of Local Wavefront Direction During Atrial Fibrillation. Comput Biology Medicine. 2017;89:497-504.

3. Reducing Ionizing Radiation During Fibrillation Ablation. I have significant expertise in the clinical use of intracardiac echocardiography (ICE) in order to eliminate ionizing radiation during AF ablation. I performed the first-in-man evaluation of the novel 3D ICE catheters and under my direction, the Yale-New Haven Hospital EP laboratory frequently hosts physicians interested in learning ICE skills and fluoroscopy reduction techniques. I am a writing group member of the 2014 Heart Rhythm Society Consensus Statement on EP Laboratory Standards, and the 2017 Heart Rhythm Society Consensus Statement on AF Ablation.

Ruisi CP, Brysiewicz N, Asnes JD, Sugeng L, Marieb M, Clancy J, Akar JG. Use of Intracardiac Echocardiography during Atrial Fibrillation Ablation. Pacing Clin Electrophysiol. 2013; 36:781-8.

a. Brysiewicz N, Mitiku T, Haleem K, Bhatt P, Al-Shaaraoui M, Clancy JF, Marieb MA, Sugeng L, Akar JG. Three-Dimensional Real-Time Intracardiac Echocardiographic Visualization of Atrial Structures Relevant to Atrial Fibrillation Ablation. JACC Imaging. 2014;7:97-100.

b. Haines DE, Beheiry S, Akar JG, Baker JL, Beinborn D, Beshai JF, Brysiewicz N, Chiu-Man C, Collins KK, Dare M, Fetterly K, Fisher JD, Hongo R, Irefin S, Lopez J, Miller JM, Perry JC, Slotwiner DJ, Tomassoni GF, Weiss E. Heart Rhythm Society Expert Consensus Statement on Electrophysiology Laboratory Standards: Process, Protocols, Equipment, Personnel, and Safety. Heart Rhythm. 2014 May 7, S1547-5271.

c. Yu R, Liu N, Lu J, Zhao X, Hu Y, Zhang J, Xu F, Tang R, Bai R, Akar JG, Dong J, Ma C. 3-Dimensional Transseptal Puncture Based on Electrographic Characteristics of Fossa Ovalis: A Fluoroscopy-Free and Echocardiography-Free Method. JACC Cardiovasc Interv. 2020 May 25;13(10):1223-1232

d. Ortiz-Leon XA, Posada-Martinez EL, Trejo-Paredes MC, Ivey-Miranda JB, Pereira J, Crandall I, DaSilva P, Bouman E, Brooks A, Gerardi C, Ugonabo I, Chen W, Houle H, Akar JG, Lin BA, McNamara RL, Lombo-Lievano B, Arias-Godinez JA, Sugeng L. Understanding tricuspid valve remodelling in atrial fibrillation using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging. 2020 May 5:jeaa058. doi: 10.1093/ehjci/jeaa058

4. Registry Studies and Electrophysiology Outcomes Research. I have strong interest and expertise in registry studies examining cardiovascular outcomes. I headed the development a unique database of patients with cardiac devices by linking multiple different data sources. We used the ACC NCDR ICD Registry to derive baseline characteristics, the Boston Scientific Altitude registry to obtain a wealth of device and physiological data obtained via remote monitoring, Medicare claims to examine hospitalizations, and the social security death index to ascertain vital status. This one-of-a-kind database of ~30,000 patients allows the examination of cardiovascular outcomes associated with detailed device-, disease- and physiological device information. Our initial projects were to examine the determinants of remote monitoring and its effect on outcomes. We are now examining the relationship between device parameters (e.g. AF burden, RV pacing, etc…) on outcomes. Not only was this work presented as a Late Breaking Trial at the Heart Rhythm Society Scientific Sessions 2014, but also the registry expertise has provided me the opportunity be a writing group member of the 2015 Consensus Statement on Remote Monitoring, lead the Yale-CORE Data Analytical Site for the national ACC NCDR AF Ablation Registry, as well being a steering committee member of the ACC NCDR Left Atrial Appendage Occlusion registry.

a. Akar, JG, Bao H, Jones P, Wang Y, Chaudhry SI, Varosy P, Masoudi FA, Stein K, Saxon LA, Curtis JP. Use of Remote Monitoring of Newly Implanted Cardioverter-Defibrillators: insights from the Patient RElated Determinants of ICD Remote Monitoring (PREDICt RM) study. Circulation. 2013;128:2372-2378.

b. Slotwiner D, Varma N, Akar JG, Annas G, Beardsall M, Fogel RI, Galizio NO, Glotzer TV, Leahy RA, Love CJ, McLean RC, Mittal S, Morichelli L, Patton KK, Raitt MH, Pietro Ricci R, Rickard J, Schoenfeld MH, Serwer GA, Shea J, Varosy P, Verma A, Yu CM. Heart Rhythm Society Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Heart Rhythm 2015;12:e69-e100.

c. Akar JG, Bao H, Jones P, Wang Y, Varosy P, Masoudi FA, Stein K, Saxon LA, Normand ST, Curtis JP. Use of Remote Monitoring Is Associated with Lower Risk of Adverse Outcomes Among Patients with Implanted Cardiac Defibrillators. Circ Arrhythm Electrophysiol 2015; 8:1173-80.

d. Al-Chekakie MO, Bao H, Jones PW, Stein KM, Marzec L, Varosy PD, Masoudi FA, Curtis JP, Akar JG. Addition of Blood Pressure and Weight Transmissions to Standard Remote Monitoring of Implantable Defibrillators and its Association with Mortality and Rehospitalization. Circulation: Cardiovas Quality Outcomes. 2017 May;10(5). pii: e003087. doi: 10.1161


Medical Subject Headings (MeSH)

Arrhythmias, Cardiac; Atrial Fibrillation; Cardiology; Catheter Ablation; Defibrillators

Research at a Glance

Yale Co-Authors

Frequent collaborators of Joseph Akar's published research.

Publications

2024

2023

Clinical Trials

Current Trials

Clinical Care

Overview

Joseph Akar, MD, PhD, is director of Yale Medicine’s Electrophysiology and Cardiac Arrhythmia Program. As an electrophysiologist, he treats the “electrical wiring” of the heart, which he describes as being not unlike the wiring in a house. The system must work properly, but the electricity in one of the chambers could get disrupted, he says. Heartbeat sequences that are too fast or slow—or otherwise irregular—can lead to serious problems, including stroke and sudden cardiac death. “It’s very important for the heart to have a uniform and consistent rhythm,” he says.

Dr. Akar treats a variety of issues that can develop in people of all ages, including those with otherwise healthy hearts. He uses techniques such as catheter ablation, a minimally invasive procedure that deliberately cauterizes the electrical short circuits in order to even out erratic rhythms, or arrhythmias. This technique has emerged as a treatment for complex problems such as refractory atrial fibrillation, which is the most common arrhythmia in humans, or ventricular tachycardia which is a major cause of sudden cardiac death. “The advent of ablation procedures for atrial fibrillation and ventricular tachycardia has really revolutionized the field,” Dr. Akar says.

He also has expertise in performing these ablations without fluoroscopy, an X-ray technique that can involve high radiation doses.

Patients who have heart rhythm problems should not hesitate to seek treatment, Dr. Akar says. “We’ve done a lot of work at Yale in refining our technology and techniques for the management of complex arrhythmias,” he says. “It’s been nothing but revolutionary as far as our ability to restore normal rhythms in cases that, in the past, we would never have dreamed that we would be able to.”

Fact Sheets

Board Certifications

  • Clinical Cardiac Electrophysiology

    Certification Organization
    AB of Internal Medicine
    Latest Certification Date
    2021
    Original Certification Date
    2005
  • Cardiovascular Disease

    Certification Organization
    AB of Internal Medicine
    Latest Certification Date
    2013
    Original Certification Date
    2003

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