Key result
Paroxysmal AF linked to elevated LA blood residence time during sinus rhythm.
Why the study?
Stroke risk in AF is thought to involve stagnant blood flow that may persist during sinus rhythm, but measuring blood flow and stasis in the LAA remains challenging.
Does paroxysmal atrial fibrillation increase left atrial blood stasis during sinus rhythm compared to controls?
Does paroxysmal atrial fibrillation increase left atrial blood stasis during sinus rhythm compared to controls?
Patient-specific computational fluid dynamics simulations demonstrate that patients with paroxysmal atrial fibrillation have elevated left atrial blood stasis even during sinus rhythm, which correlates strongly with reduced left atrial ejection fraction.
LA stasis may persist in PAF during sinus rhythm; hypothesis-generating for thromboembolism risk and needs prospective validation.
Introduction Atrial fibrillation (AF) is associated with an increased risk of stroke, often caused by thrombi that form in the left atrium (LA), and especially in the left atrial appendage (LAA). The underlying mechanism is not fully understood but is thought to be related to stagnant blood flow, which might be present despite sinus rhythm. However, measuring blood flow and stasis in the LAA is challenging due to its small size and low velocities. We aimed to compare the blood flow and stasis in the left atrium of paroxysmal AF patients with controls using computational fluid dynamics (CFD) simulations. Methods The CFD simulations were based on time-resolved computed tomography including the patient-specific cardiac motion. The pipeline allowed for analysis of 21 patients with paroxysmal AF and 8 controls. Stasis was estimated by computing the blood residence time. Results and Discussion Residence time was elevated in the AF group ( p < 0.001). Linear regression analysis revealed that stasis was strongest associated with LA ejection ratio ( p < 0.001, R 2 = 0.68) and the ratio of LA volume and left ventricular stroke volume ( p < 0.001, R 2 = 0.81). Stroke risk due to LA thrombi could already be elevated in AF patients during sinus rhythm. In the future, patient specific CFD simulations may add to the assessment of this risk and support diagnosis and treatment.
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Bäck et al. (2023) studied this question. Residence time of blood flow in the left atrium was significantly elevated in paroxysmal atrial fibrillation patients during sinus rhythm (p < 0.001).
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