About

Sarah Yukiko Asaki, MD, CEPS-P, FAAP, is an Associate Professor (Clinical) in the Department of Pediatrics at the University of Utah, specializing in Pediatric Electrophysiology and Pediatric Cardiology. Her clinical interests include arrhythmia and antiarrhythmic management, radiofrequency and cryoablation, and pacemaker and implantable cardioverter/defibrillator (ICD) implantation and management. Her current research focuses on inherited channelopathies and sudden arrhythmogenic death syndromes, as well as outcomes and management strategies related to pacemakers and ICDs. Dr. Asaki's educational background includes a B.A. in Biology from St. Mary's College of Maryland, an M.D. from Mount Sinai School of Medicine, and specialized training through internships, residencies, and fellowships at institutions such as Dartmouth-Hitchcock Medical Center, Baylor College of Medicine, and Texas Children's Hospital.

Research topics

• Cardiology
• Medicine
• Internal medicine
• Radiology
• Pediatrics
• Genetics

Selected publications

• Resolution of Refractory Multifocal Atrial Tachycardia in <scp>C</scp> ostello Syndrome Using Trametinib: A Case Supporting <scp>MEK</scp> Inhibitors as Targeted, Specific Antiarrhythmic

  American Journal of Medical Genetics Part A · 2026-04-27

  articleOpen access

  Arrhythmias affect approximately half of patients with Costello syndrome (CS, OMIM # 218040), with non-reentrant atrial tachycardia being the most common. This case describes an infant with Costello syndrome carrying the pathogenic HRAS c.34G>A (p.G12S) variant who developed early-onset, drug-refractory multifocal atrial tachycardia (MAT). Despite multiple antiarrhythmic therapies, rhythm control remained inadequate until trametinib was initiated, resulting in rapid resolution of MAT and allowing stepwise discontinuation of adjunct antiarrhythmics. Although MAT did not recur after the MEK inhibitor was stopped, the patient subsequently developed hypertrophic cardiomyopathy only after trametinib was discontinued, suggesting a potential disease-modifying cardioprotective effect during active treatment. This case supports MEK inhibition as a targeted antiarrhythmic strategy in Costello syndrome, with benefits that may extend beyond acute rhythm stabilization to include prevention of cardiac hypertrophy. While spontaneous resolution of MAT can occur in Costello syndrome, the rapid and sustained response in this patient strengthens the hypothesis that trametinib exerts a direct antiarrhythmic effect.

  PublisherDOI

• Abstract 4359485: Impact of Social Determinants of Health on Emergency Department Use Following Congenital Heart Surgery

  Circulation · 2025-11-03

  article

  Background: Emergency department utilization is common for patients with congenital heart disease (CHD) after congenital heart surgery. Children with CHD who present to the ED are more likely to require hospitalization, incur higher healthcare costs, and experience worse outcomes compared to children without CHD. The impact of social determinants of health (SDOH) on ED utilization following CHD surgery is not well described. Our objective was to evaluate the relationship between SDOH and ED utilization in children within 12 months following CHD surgery. Methods: This is a retrospective cohort study of all patients, aged 0-21 years, who underwent cardiac surgery at Primary Children’s Hospital between 2014 and 2023. Patients were categorized by the number of ED visits following surgery (0, 1, 2-3, or 4+) and by disposition from ED. Associations between SDOH and ED utilization and disposition were evaluated using ordinal logistic regression with generalized estimating equations to account for within-subject correlation due to multiple surgeries per patient and multiple ED visit per surgery. Results: Among 3,858 surgeries analyzed (43% female, mean age 3.3 years) a higher ED utilization was associated with Black/African American and Native Hawaiian or other Pacific Islander (p=0.007 and &lt;0.001, respectively), Hispanic/Latino ethnicity (P=0.01), and languages other than English or Spanish (p=0.007). Patients with more ED visits were more likely to be younger at time of surgery (p=0.015), publicly insured (p&lt;0.001) and reside in areas with lower child opportunity index (COI) (p=0.008). Number of ED visits was not associated with either distance to the main hospital ED or to the presenting ED. Higher STAT mortality category and single ventricle status were not associated with more ED visits but were associated with admission or transfer when presenting to ED (p&lt;0.001). Patients who were Hispanic/Latino, lived in areas with lower COI or had public insurance were more likely to be discharged from the ED, while patients from rural areas were more likely to be admitted. Results are summarized in Tables I and II. Conclusion: ED utilization following CHD surgery is associated with markers of socioeconomic vulnerability, including race, ethnicity, language, and childhood opportunity index as well as proximity to familiar emergency departments. These findings highlight the need for targeted discharge interventions and planning for these groups at higher risk of ED utilization.

  PublisherDOI

• Intersection of Arrhythmogenic Genetic Heart Diseases and Transgender Hormone Therapy

  JACC. Clinical electrophysiology · 2025-10-11

  article
  PublisherDOI

• PO-01-146 SUCCESSFUL MANAGEMENT OF MULTIFOCAL ATRIAL TACHYCARDIA WITH TRAMETINIB IN COSTELLO SYNDROME

  Heart Rhythm · 2025-04-01 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• Children are Less Likely Than Adults to Develop Complete Heart Block Following TAVR

  Pediatric Cardiology · 2025-05-13 · 1 citations

  articleOpen accessSenior author

  TAVR is an alternative to surgical aortic valve [AoV] replacement. In adults, rates of atrioventricular block [AVB] requiring permanent pacemaker [PPM] placement in the modern era are 4-24%. Post-TAVR conduction abnormality incidence and risk factors are unknown in children and young adults. Describe post-TAVR conduction abnormalities in children and young adults. Retrospective single-center review of patients undergoing TAVR (9/2014 to 6/2021). Patients with pre-existing complete AVB or PPM were excluded (N = 1). The relationship between described adult risk factors for AVB and primary outcome of new conduction abnormality was assessed. Of 28 cases (Ages 3.5-22 y), 50% were male and 43% had isolated AoV disease, and the remainder with multilevel obstructive left-sided heart disease (29%) or complex congenital heart disease (29%). Baseline conduction abnormality was present in 57% (16/28), with right bundle branch block the most prevalent (9, 56%). Post-TAVR, acute- and late-onset conduction abnormalities occurred in 9 and 2 patients, respectively, and resolved in 8/11 patients during follow-up. One patient required PPM for complete heart block. There was no association between new conduction abnormality and previously reported adult risk factors-baseline RBBB, membranous septum length, valve implantation depth, or degree of valve oversizing. There was no relationship between outcome and baseline conduction abnormality nor history of multiple AoV interventions. In our pediatric series, AVB requiring PPM was rare following TAVR, with an incidence 3.6%-lower than average rates reported in adult literature. We identified no association of conduction abnormality with described adult risk factors.

  PublisherOA PDFDOI

• Dual- vs Single-Chamber Ventricular Pacing in Isolated Congenital Complete Atrioventricular Block in Infancy

  JACC. Clinical electrophysiology · 2025-02-26 · 4 citations

  article
  PublisherDOI

• Intracardiac echocardiography in paediatric and congenital cardiac ablation shortens procedure duration and improves success without complications

  EP Europace · 2024-02-01 · 12 citations

  articleOpen access

  AIMS: Common to adult electrophysiology studies (EPSs), intracardiac echocardiography (ICE) use in paediatric and congenital heart disease (CHD) EPS is limited. The purpose of this study was to assess the efficacy of ICE use and incidence of associated complications in paediatric and CHD EPS. METHODS AND RESULTS: This single-centre retrospective matched cohort study reviewed EPS between 2013 and 2022. Demographics, CHD type, and EPS data were collected. Intracardiac echocardiography cases were matched 1:1 to no ICE controls to assess differences in complications, ablation success, fluoroscopy exposure, procedure duration, and arrhythmia recurrence. Cases and controls with preceding EPS within 5 years were excluded. Intracardiac echocardiography cases without an appropriate match were excluded from comparative analyses but included in the descriptive cohort. We performed univariable and multivariable logistic regression to assess associations between variables and outcomes. A total of 335 EPS were reviewed, with ICE used in 196. The median age of ICE cases was 15 [interquartile range (IQR) 12-17; range 3-47] years, and median weight 57 [IQR 45-71; range 15-134] kg. There were no ICE-related acute or post-procedural complications. There were 139 ICE cases matched to no ICE controls. Baseline demographics and anthropometrics were similar between cases and controls. Fluoroscopy exposure (P = 0.02), procedure duration (P = 0.01), and arrhythmia recurrence (P = 0.01) were significantly lower in ICE cases. CONCLUSION: Intracardiac echocardiography in paediatric and CHD ablations is safe and reduces procedure duration, fluoroscopy exposure, and arrhythmia recurrence. However, not every arrhythmia substrate requires ICE use. Thoughtful selection will ensure the judicious and strategic application of ICE to enhance outcomes.

  PublisherOA PDFDOI

• Duodromic tachycardia: A case report of a rare presentation of wide complex supraventricular tachycardia

  HeartRhythm Case Reports · 2024-02-22 · 1 citations

  articleOpen access

  Key Teaching Points•A presenting wide complex tachycardia carries a broad differential, and an organized approach can elucidate the mechanism.•Subtle electrocardiographic changes following adenosine and cardioversion may provide evidence for rare and unique reentry mechanisms.•Electrophysiology study maneuvers can be used to differentiate complex reentrant arrhythmia mechanisms. •A presenting wide complex tachycardia carries a broad differential, and an organized approach can elucidate the mechanism.•Subtle electrocardiographic changes following adenosine and cardioversion may provide evidence for rare and unique reentry mechanisms.•Electrophysiology study maneuvers can be used to differentiate complex reentrant arrhythmia mechanisms.

  PublisherOA PDFDOI

• Mental Health Care for Children with Heart Disease and Their Families: Practical Approaches and Considerations for the Pediatric and Pediatric Cardiology Clinician

  Pediatric Cardiology · 2024-05-16 · 3 citations

  review
  PublisherDOI

• Addressing Disparities in Pediatric Congenital Heart Disease: A Call for Equitable Health Care

  Journal of the American Heart Association · 2024-06-27 · 19 citations

  reviewOpen access

  While significant progress has been made in reducing disparities within the US health care system, notable gaps remain. This article explores existing disparities within pediatric congenital heart disease care. Congenital heart disease, the most common birth defect and a leading cause of infant death, has garnered substantial attention, revealing certain disparities within the US health care system. Factors such as race, ethnicity, insurance coverage, socioeconomic status, and geographic location are all commonalities that significantly affect health disparities in pediatric congenital heart disease. This comprehensive review sheds light on disparities from diverse perspectives in pediatric care, demonstrates the inequities and inequalities leading to these disparities, presents effective solutions, and issues a call to action for providers, institutions, and the health care system. Recognizing and addressing these disparities is imperative for ensuring equitable care and enhancing the long-term well-being of children affected by congenital heart disease. Implementing robust, evidence-based frameworks that promote responsible and safe interventions is fundamental to enduring change.

  PublisherDOI

Frequent coauthors

• Susan P. Etheridge

  Primary Children's Hospital

  40 shared

• Mary C. Niu

  University of Utah

  36 shared

• Jeffrey J. Kim

  16 shared

• Christina Y. Miyake

  Texas Children's Hospital

  16 shared

• Christina Ronai

  Boston Children's Hospital

  14 shared

• Lindsey Gakenheimer‐Smith

  University of Utah

  14 shared

• Thomas Pilcher

  Primary Children's Hospital

  12 shared

• Thomas A. Pilcher

  12 shared

Education

• M.D.

  Mount Sinai

• B.S.

  Texas Children's/Baylor

Awards & honors

• FAAP (Fellow of the American Academy of Pediatrics)
• FHRS (Fellow of the Heart Rhythm Society)