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Computational Modelling of Electro-Mechanical Coupling in the Atria and Its Changes During Atrial Fibrillation

机译:心房中机电耦合的计算模型及其在心房纤颤过程中的变化

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Atrial fibrillation (AF) is a very common, multifaceted disease that affects atrial structure as well as electrophysiological and biomechanical function. However, the mechanistic links between structural and functional factors underlying AF are poorly understood. To explore these mechanisms, a 3D atrial electro-mechanical (EM) model was developed that includes 3D atrial geometry based on the Visible Female dataset, rule-based fibre orientation, CRN human atrial electrophysiology model and activation-based mechanical contraction model. Electrical activation in the 3D atria was simulated under control condition and two AF scenarios: sinus rhythm (SR), functional re-entry in the right atrium (RA) and structural re-entry around fibrotic patches in the left atrium (LA). Fibrosis distributions were obtained from patient LGE MR1 data. In both AF scenarios, re-entrant behaviours led to substantial reductions in the displacement at peak contraction compared to SR. Specifically, high-frequency reentry led to a decrease in maximal displacement from 6.8 to 6.1 mm in the posterior RA, and a larger decrease from 7.8 to 4.5 mm in the LA in the presence of fibrotic patches. The simulated displacement values agreed with available clinical data. In conclusion, the novel model of EM coupling in the 3D human atria provided new insights into the mechanistic links between atrial electrics and mechanics during normal activation and re-entry sustaining AF. Re-entry in the RA and LA resulted in weaker contractions compared to SR, with additional effect of fibrosis on the atrial wall stiffness further reducing the contraction.
机译:心房颤动(AF)是一种非常常见的多方面疾病,会影响心房结构以及电生理和生物力学功能。然而,AF的结构性和功能性因素之间的机制联系了解甚少。为了探索这些机制,开发了3D心房机电(EM)模型,该模型包括基于可见女性数据集,基于规则的纤维方向,CRN人心房电生理模型和基于激活的机械收缩模型的3D心房几何形状。在控制条件和两种AF情况下模拟了3D心房中的电激活:窦性心律(SR),右心房(RA)中的功能性折返和左心房纤维化斑块周围的结构性折返(LA)。从患者LGE MR1数据获得纤维化分布。在两种AF场景中,与SR相比,重入行为导致峰值收缩时的位移大大降低。具体来说,高频折返导致后RA的最大位移从6.8 mm减小到6.1 mm,而在存在纤维化斑块的情况下,LA的最大位移从7.8 mm减小到4.5 mm。模拟的位移值与可用的临床数据一致。总之,在3D人心房中EM耦合的新颖模型为正常激活和重新进入持续性AF期间心房电和力学之间的机械联系提供了新见解。与SR相比,RA和LA的再次进入导致收缩较弱,纤维化对房壁硬度的附加作用进一步降低了收缩。

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