Multiphysics Modeling of the Atrial Systole under Standard Ablation Strategies

The aim of this study was to develop a computational framework to compare the impact of standard ablation concepts on the mechanical performance of the atria, since different line combinations cannot be applied in practice to the same patient. For this purpuse, we coupled electro-mechano-hemodynamic mathematical models based on biophysical principles and simulate the contractile performance of the atria. We computed systolic pressures and volumes in two patient-specific atrial geometries (one of normal size and one hypertrophied) with various ablation concepts. We found that our computational model is able to detect the differences in the left atrial contractility and ejection fraction for various electrical activation sequences resulting from different ablation line combinations. We show that multiphysics modeling has the potential to quantify the hemodynamic performance of left atria for different ablation lines, which could be used as additional pre-operative clinical information for the choice of the ablation concept in the future.

[1]  P. Wolf,et al.  Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. , 1991, Stroke.

[2]  P Moireau,et al.  Estimation of tissue contractility from cardiac cine-MRI using a biomechanical heart model , 2012, Biomechanics and modeling in mechanobiology.

[3]  Prashanthan Sanders,et al.  Approaches to catheter ablation for persistent atrial fibrillation. , 2015, The New England journal of medicine.

[4]  Ashok J. Shah,et al.  Driver Domains in Persistent Atrial Fibrillation , 2014, Circulation.

[5]  C. A. Figueroa,et al.  Sequential identification of boundary support parameters in a fluid-structure vascular model using patient image data , 2012, Biomechanics and Modeling in Mechanobiology.

[6]  Kawal S. Rhode,et al.  Personalization of Atrial Anatomy and Electrophysiology as a Basis for Clinical Modeling of Radio-Frequency Ablation of Atrial Fibrillation , 2013, IEEE Transactions on Medical Imaging.

[7]  Seil Oh,et al.  The anatomical characteristics of three different endocardial lines in the left atrium: evaluation by computed tomography prior to mitral isthmus block attempt. , 2012, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[8]  W. Haverkamp,et al.  Comparison of the anterior and posterior mitral isthmus ablation lines in patients with perimitral annulus flutter or persistent atrial fibrillation , 2015, Journal of Interventional Cardiac Electrophysiology.

[9]  Olaf Dössel,et al.  Preventive Ablation Strategies in a Biophysical Model of Atrial Fibrillation Based on Realistic Anatomical Data , 2008, IEEE Transactions on Biomedical Engineering.

[10]  S. Knecht,et al.  Atrial Structure and Function 5 Years After Successful Ablation for Persistent Atrial Fibrillation: An MRI Study , 2014, Journal of cardiovascular electrophysiology.

[11]  Robert Lemery,et al.  Human Study of Biatrial Electrical Coupling: Determinants of Endocardial Septal Activation and Conduction Over Interatrial Connections , 2004, Circulation.

[12]  Christophe Geuzaine,et al.  Gmsh: A 3‐D finite element mesh generator with built‐in pre‐ and post‐processing facilities , 2009 .

[13]  O. Dossel,et al.  Adaptation of a minimal four-state cell model for reproducing atrial excitation properties , 2008, 2008 Computers in Cardiology.

[14]  A. Hofman,et al.  Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. , 2006, European heart journal.

[15]  Claudia Herrera,et al.  Small or Large Isolation Areas Around the Pulmonary Veins for the Treatment of Atrial Fibrillation?: Results From a Prospective Randomized Study , 2007, Circulation.

[16]  Cesare Corrado,et al.  Identification of weakly coupled multiphysics problems. Application to the inverse problem of electrocardiography , 2015, J. Comput. Phys..

[17]  Philippe Moireau,et al.  Identification of artery wall stiffness: in vitro validation and in vivo results of a data assimilation procedure applied to a 3D fluid-structure interaction model. , 2014, Journal of biomechanics.

[18]  Michel Haïssaguerre,et al.  Impact of Varying Ablation Patterns in a Simulation Model of Persistent Atrial Fibrillation , 2007, Pacing and clinical electrophysiology : PACE.

[19]  Yubing Shi,et al.  Review of Zero-D and 1-D Models of Blood Flow in the Cardiovascular System , 2011, Biomedical engineering online.

[20]  H. Mond,et al.  Electrical remodeling of the atria following loss of atrioventricular synchrony: a long-term study in humans. , 1999, Circulation.

[21]  P. Kirchhof,et al.  Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. , 2011, Physiological reviews.

[22]  Wolfgang A. Wall,et al.  Personalization of Cardiac Fiber Orientations from Image Data Using the Unscented Kalman Filter , 2013, FIMH.

[23]  H. Mond,et al.  Mechanical remodeling of the left atrium after loss of atrioventricular synchrony. A long-term study in humans. , 1999, Circulation.

[24]  Prashanthan Sanders,et al.  Outcomes of long-standing persistent atrial fibrillation ablation: a systematic review. , 2010, Heart rhythm.

[25]  Luca F. Pavarino,et al.  Mathematical cardiac electrophysiology/ Piero Colli Franzone, Luca F. Pavarino, Simone Scacchi , 2014 .

[26]  D. Shah,et al.  Electrophysiologic and clinical consequences of linear catheter ablation to transect the anterior left atrium in patients with atrial fibrillation. , 2004, Heart rhythm.

[27]  Wolfgang A. Wall,et al.  Cardiac Fibers Estimation from Arbitrarily Spaced Diffusion Weighted MRI , 2015, FIMH.

[28]  Frédérique Clément,et al.  A Biomechanical Model of Muscle Contraction , 2001, MICCAI.

[29]  Trine Krogh-Madsen,et al.  Effects of Electrical and Structural Remodeling on Atrial Fibrillation Maintenance: A Simulation Study , 2012, PLoS Comput. Biol..

[30]  P. Tallec,et al.  An energy-preserving muscle tissue model: formulation and compatible discretizations , 2012 .

[31]  M. Friedrich,et al.  Evaluation of left atrial contraction contribution to left ventricular filling using cardiovascular magnetic resonance , 2013, Journal of magnetic resonance imaging : JMRI.

[32]  Ashok J. Shah,et al.  Validation of novel 3-dimensional electrocardiographic mapping of atrial tachycardias by invasive mapping and ablation: a multicenter study. , 2013, Journal of the American College of Cardiology.

[33]  S. Ho,et al.  Electroanatomic Analysis of Sinus Impulse Propagation in Normal Human Atria , 2002, Journal of cardiovascular electrophysiology.

[34]  Henggui Zhang,et al.  Effects of Persistent Atrial Fibrillation-Induced Electrical Remodeling on Atrial Electro-Mechanics – Insights from a 3D Model of the Human Atria , 2015, PloS one.

[35]  Kawal S. Rhode,et al.  Towards personalized clinical in-silico modeling of atrial anatomy and electrophysiology , 2012, Medical & Biological Engineering & Computing.

[36]  David Keane,et al.  2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. , 2012, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[37]  J Clémenty,et al.  Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. , 1998, The New England journal of medicine.

[38]  Robert H. Anderson,et al.  Atrial structure and fibres: morphologic bases of atrial conduction. , 2002, Cardiovascular research.

[39]  W. Wall,et al.  Towards efficient uncertainty quantification in complex and large-scale biomechanical problems based on a Bayesian multi-fidelity scheme , 2014, Biomechanics and Modeling in Mechanobiology.

[40]  F. Fenton,et al.  Minimal model for human ventricular action potentials in tissue. , 2008, Journal of theoretical biology.

[41]  F A Mathewson,et al.  The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. , 1995, The American journal of medicine.