Towards personalized clinical in-silico modeling of atrial anatomy and electrophysiology

Abstract

Computational atrial models aid the understanding of pathological mechanisms and therapeutic measures in basic research. The use of biophysical models in a clinical environment requires methods to personalize the anatomy and electrophysiology (EP). Strategies for the automation of model generation and for evaluation are needed. In this manuscript, the current efforts of clinical atrial modeling in the euHeart project are summarized within the context of recent publications in this field. Model-based segmentation methods allow for the automatic generation of ready-to-simulate patient-specific anatomical models. EP models can be adapted to patient groups based on a-priori knowledge and to the individual without significant further data acquisition. ECG and intracardiac data build the basis for excitation personalization. Information from late enhancement (LE) MRI can be used to evaluate the success of radio-frequency ablation (RFA) procedures and interactive virtual atria pave the way for RFA planning. Atrial modeling is currently in a transition from the sole use in basic research to future clinical applications. The proposed methods build the framework for model-based diagnosis and therapy evaluation and planning. Complex models allow to understand biophysical mechanisms and enable the development of simplified models for clinical applications.

Heterogeneous and anisotropic integrative model of pulmonary veins: computational study of arrhythmogenic substrate for atrial fibrillation

“…Biophysically detailed three-dimensional computational models have been developed for major parts of the heart [7,9], with several models accounting for various details of atrial electrophysiology and anatomy [8,9,[26][27][28][29]. Comprehensive review of such models can be found elsewhere [9].…”

“…Fibre orientation has been included in atrial models manually based on anatomical observations [8,26,27] or semi-automatically based on known atrial activation patterns [28,29]. Besides, even the most recent atrial models [8,28,29] have not accounted for electrophysiological heterogeneity and anisotropy of the PV region, which are crucial in the genesis of AF [1][2][3][4][5]. Our three-dimensional model of the canine PV region overcomes such limitations and provides a missing link in the large-scale modelling of the entire threedimensional atria and heart.…”

Textbook of Personalized Medicine

“…They also incorporated clinical knowledge about how cardiovascular disease disturbs the correct functioning of the heart at these levels. Atrial modeling is currently in a transition from the sole use in basic research to future clinical applications (Krueger et al 2013 ).…”

A Fully Adaptive Multiresolution Algorithm for Atrial Arrhythmia Simulation on Anatomically Realistic Unstructured Meshes

“…2, 11.9 K nodes, average internodal distance of 2.0 mm). The latter was composed of several connected structures, manually added to the atrial chambers, with geometry and fiber orientation mimicking [30], [31].…”

“…Our adaptive algorithm may favor the diffusion of patient-specific AF simulations [31] in the clinical setting by reducing computational costs and hardware requirements. For instance, thanks to the 90% decrease in workload, simulations could be accurately performed on nondedicated desktop computers in clinically acceptable times (1 h for 1 s simulation).…”