Abstract
Atrial fibrillation (AF) is considered the most common human arrhythmia. Around 99% of thrombi in non-valvular AF are formed in the left atrial appendage (LAA). Studies suggest that abnormal LAA haemodynamics and the subsequently stagnated flow are the factors triggering clot formation. However, the relation between LAA morphology, the blood pattern and the triggering is not fully understood. Moreover, the impact of structures such as the pulmonary veins (PVs) on LA haemodynamics has not been thoroughly studied due to the difficulties of acquiring appropriate data. On the other hand, in-silico studies and flow simulations allow a thorough analysis of haemodynamics, analysing the 4D nature of blood flow patterns under different boundary conditions. However, the reduced number of cases reported on the literature of these studies has been a limitation. The main goal of this work was to study the influence of PVs on left atrium (LA) and LAA haemodynamics. Computational fluid dynamics simulations were run on 52 patients, the largest cohort so far in the literature, where different parameters were individually studied: pulmonary veins orientation and configuration; LAA and LA volumes and its ratio; and flow velocities. Our computational analysis showed how the right pulmonary vein height and angulation have a great influence on LA haemodynamics. Additionally, we found that LAA with great bending with its tip pointing towards the mitral valve could contribute to favour flow stagnation.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
Notes
References
Rahman, F., Kwan, G.F., Benjamin, E.J.: Global epidemiology of atrial fibrillation. Nat. Rev. Cardiol. 11(11), 639–654 (2014)
Cresti, A., et al.: Prevalence of extra-appendage thrombosis in non-valvular atrial fibrillation and atrial flutter in patients undergoing cardioversion: a large transoesophageal echo study. EuroIntervention : Journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 15(3), e225–e230 (2019)
Di Biase, L., et al.: Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J. Am. Coll. Cardiol. 60(6), 531–538 (2012)
Watson, T., Shantsila, E., Lip, G.Y.H.: Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. Lancet 373(9658), 155–166 (2009)
Naser, A., et al.: Left atrial blood stasis and Von Willebrand factor-ADAMTS13 homeostasis in atrial fibrillation. Arterioscler. Thromb. Vasc. Biol. 31(11), 2760–2766 (2011)
Cronin, P., et al.: Normative analysis of pulmonary vein drainage patterns on multidetector CT With Measurements of pulmonary vein ostial diameter and distance to first bifurcation. Acad. Radiol. 14(2), 178–188 (2007)
Marom, E.M., Herndon, J.E., Kim, Y.H., McAdams, H.P.: Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology 230(3), 824–829 (2004)
Beigel, R., Wunderlich, N.C., Ho, S.Y., Arsanjani, R., Siegel, R.J.: The left atrial appendage: Anatomy, function, and noninvasive evaluation. JACC: Cardiovasc. Imaging 7(12), 1251–1265 (2014)
Markl, M., et al.: Assessment of left atrial and left atrial appendage flow and stasis in atrial fibrillation. J. Cardiovasc. Magn. Reson. 17(1), M3 (2015)
Guadalupe, G.I., et al.: Sensitivity analysis of geometrical parameters to study haemodynamics and thrombus formation in the left atrial appendage. Int. J. Numer. Meth. Biomed. Eng. Acepted(ja), 122–140 (2018)
Fumagalli, I., et al.: An image-based computational hemodynamics study of the Systolic Anterior Motion of the mitral valve. Comput. Biol. Med. 123, 103922 (2020)
Otani, T., et al.: A computational framework for personalized blood flow analysis in the human left atrium. Ann. Biomed. Eng. 44(11), 3284–3294 (2016). https://doi.org/10.1007/s10439-016-1590-x
Veronesi, F., et al.: Quantification of mitral apparatus dynamics in functional and ischemic mitral regurgitation using real-time 3-dimensional echocardiography. J. Am. Soc. Echocardiograph. 21(4), 347–354 (2008)
Bône, Alexandre, Louis, Maxime, Martin, Benoît, Durrleman, Stanley: Deformetrica 4: an open-source software for statistical shape analysis. In: Reuter, Martin, Wachinger, Christian, Lombaert, Hervé, Paniagua, Beatriz, Lüthi, Marcel, Egger, Bernhard (eds.) ShapeMI 2018. LNCS, vol. 11167, pp. 3–13. Springer, Cham (2018). https://doi.org/10.1007/978-3-030-04747-4_1
Yaghi, S., et al.: The left atrial appendage morphology is associated with embolic stroke subtypes using a simple classification system: a proof of concept study. J. Cardiovasc. Comput. Tomograph. 14(1), 27–33 (2020)
Funding
This work was supported by the Agency for Management of University and Research Grants of the Generalitat de Catalunya under the Grants for the Contracting of New Research Staff Programme - FI (2020 FI_B 00608) and the Spanish Ministry of Economy and Competitiveness under the Programme for the Formation of Doctors (PRE2018-084062), the Maria de Maeztu Units of Excellence Programme (MDM-2015-0502) and the Retos Investigación project (RTI2018-101193-B-I00). Additionally, this work was supported by the H2020 EU SimCardioTest project (Digital transformation in Health and Care SC1-DTH-06-2020; grant agreement No. 101016496) and the European project PARIS (ID35).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this paper
Cite this paper
Mill, J. et al. (2021). In-Silico Analysis of the Influence of Pulmonary Vein Configuration on Left Atrial Haemodynamics and Thrombus Formation in a Large Cohort. In: Ennis, D.B., Perotti, L.E., Wang, V.Y. (eds) Functional Imaging and Modeling of the Heart. FIMH 2021. Lecture Notes in Computer Science(), vol 12738. Springer, Cham. https://doi.org/10.1007/978-3-030-78710-3_58
Download citation
DOI: https://doi.org/10.1007/978-3-030-78710-3_58
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-78709-7
Online ISBN: 978-3-030-78710-3
eBook Packages: Computer ScienceComputer Science (R0)