My research has focused on the more complex heart rhythm disorders we encounter, those that occur due to the presence of scar within the heart.
The two most common types are complex “Atrial Tachycardia” (AT) that can arise from scar created from prior A-Fib ablation or cardiac surgery, and “Ventricular Tachycardia” (VT) that can occur from the scar formed following a heart attack.
The mapping and ablation of these scar related arrhythmias is more challenging, and in my research, I have aimed to improve outcomes.
PhD
Much of my research was conducted at the National Heart & Lung Institute in Imperial College London during my PhD, and involved the development of algorithms to take “Ripple Mapping” into routine clinical practice during AT & VT procedures. Links to some of my full manuscripts are below.
Ripple Mapping presents the complex electrical data we collect within the heart in a completely distinct fashion to other technologies.
I found that our approach with Ripple Mapping allowed for a 95% success rate in complex AT ablation.
https://www.ahajournals.org/doi/10.1161/CIRCEP.116.004072
I subsequently showed that this approach to Ripple Mapping was superior to the current mapping methods used (91% vs 74%) in a head to head 100 patient AT ablation trial.
https://www.ahajournals.org/doi/full/10.1161/CIRCEP.118.007394
Within ventricular scar, our approach has offered us new insight into the best ablation targets that the heart rhythm community is otherwise trying to understand (85% acute success rate).
https://www.ahajournals.org/doi/10.1161/CIRCEP.116.004072
I remain in close collaboration with the heart rhythm team at Imperial College London, co-supervising a PhD fellow, and we are testing how effective our approaches to VT ablation can be in other centres.
Ripple Mapping has been incorporated into the CARTO 3D mapping system, the most common mapping system used in hospitals, meaning that these approaches can be used by EPs worldwide. I have travelled across the world (from Paris, to San Francisco, to Taiwan) to discuss this work at international meetings, and now teach this approach to Electrophysiologists throughout Europe. I exclusively adopt this approach in my own clinical practice.
In 2019, I received the highest scoring clinical abstract award for this research from the Heart Rhythm Society, one of the most prestigious accolades in EP. I was honoured to collect the award from 2 giants in the field, Dr Eric Prystowsky and Dr Thomas Deering.
I am indebted to the mentorship and genius of Professor Prapa Kanagaratnam, Hammersmith Hospital, who supervised my PhD, and whom I continue to collaborate with as we strive to improve ablation success.
Dr Luther’s research in Liverpool Heart & Chest Research
Having completed a 2yr NIHR North-West research scholarship, I am now appointed Honorary Senior Lecturer in the University of Liverpool. I am driving the complex mapping research programme within LHCH.
⦁ I am chief investigator for a multicentre industry funded UK randomised trial (Ripple AT plus) exploring optimal ablation strategies in patients with atrial scar.
https://link.springer.com/article/10.1007/s10840-023-01607-8
⦁ I am leading a programme of research to better characterise ventricular scar using “dynamic voltage maps” during VT ablation, and improve our approaches to Afib ablation.
An approach to help differentiate postinfarct scar from borderzone tissue using Ripple Mapping during ventricular tachycardia ablation. J Cardiovasc Electrophysiol. 2022 Dec 7.
https://onlinelibrary.wiley.com/doi/10.1111/jce.15766
Delineating postinfarct ventricular tachycardia substrate with dynamic voltage mapping in areas of omnipolar vector disarray. Heart Rhythm O2. 2024 Feb 27;5(4):224-233.
https://www.heartrhythmopen.com/article/S2666-5018(24)00032-1/fulltext
Lesion metrics and 12-month outcomes of very-high power short duration radiofrequency ablation (90W/4 s) under mild conscious sedation.
https://onlinelibrary.wiley.com/doi/10.1111/jce.16269
⦁ As lead clinician for digital innovation within LHCH, I spearheaded the introduction of CARTONET into the trust. We described the utility of this technology in facilitating multicentre research:
The feasibility of utilising a cloud-based storage and analysis software in multicentre clinical electrophysiology research. EP Europace, Volume 25, Issue Supplement_1, June 2023
https://academic.oup.com/europace/article/25/Supplement_1/euad122.544/7176567
Other research activities:
I have studied the effectiveness of robotic navigation during VT ablation.
Non-randomised comparison of acute and long-term outcomes of robotic versus manual ventricular tachycardia ablation in a single centre ischemic cohort.
Luther V et al, J Interv Card Electrophysiol. 2015 Aug;43(2):175-85.
I have studied the application of ultra-high density Rhythmia (Boston Scientific) mapping system in complex AT ablation.
Visualizing Localized Reentry With Ultra-High Density Mapping in Iatrogenic Atrial Tachycardia: Beware Pseudo-Reentry.
Luther V et al Circ Arrhythm Electrophysiol. 2017 Apr;10(4):e004724.
I have >50 peer reviewed publications – the full list is available at pubmed