The role of personalized atrial modeling in understanding atrial fibrillation mechanisms and improving treatment

Int J Cardiol. 2019 Jul 15:287:139-147. doi: 10.1016/j.ijcard.2019.01.096. Epub 2019 Jan 31.

Abstract

Atrial fibrillation is the most common arrhythmia in humans and is associated with high morbidity, mortality and health-related expenses. Computational approaches have been increasingly utilized in atrial electrophysiology. In this review we summarize the recent advancements in atrial fibrillation modeling at the organ scale. Multi-scale atrial models now incorporate high level detail of atrial anatomy, tissue ultrastructure and fibrosis distribution. We provide the state-of-the art methodologies in developing personalized atrial fibrillation models with realistic geometry and tissue properties. We then focus on the use of multi-scale atrial models to gain mechanistic insights in AF. Simulations using atrial models have provided important insight in the mechanisms underlying AF, showing the importance of the atrial fibrotic substrate and altered atrial electrophysiology in initiation and maintenance of AF. Last, we summarize the translational evidence that supports incorporation of computational modeling in clinical practice for development of personalized treatment strategies for patients with AF. In early-stages clinical studies, AF models successfully identify patients where pulmonary vein isolation alone is not adequate for treatment of AF and suggest novel targets for ablation. We conclude with a summary of the future developments envisioned for the field of atrial computational electrophysiology.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / physiopathology
  • Atrial Fibrillation* / surgery
  • Catheter Ablation / methods*
  • Computer Simulation*
  • Heart Atria / diagnostic imaging
  • Heart Atria / physiopathology*
  • Humans
  • Imaging, Three-Dimensional
  • Magnetic Resonance Imaging, Cine
  • Models, Cardiovascular*
  • Tomography, X-Ray Computed