The Impact of Standard Ablation Strategies for Atrial Fibrillation on Cardiovascular Performance in a Four-Chamber Heart Model

Figures

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  Figure 1. Surfaces on which boundary conditions are applied: the endocardial surfaces \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\Gamma_{\text{n}} = \Gamma_{\text{LV}}\cup \Gamma_{\text{RV}}\cup \Gamma_{\text{LA}}\cup \Gamma_{\text{RA}}$$\end{document}Γn=ΓLV∪ΓRV∪ΓLA∪ΓRA are used for the pressure boundary condition; \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\Gamma_{\text{D}}$$\end{document}ΓD is used as a zero displacement Dirichlet boundary; and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\Gamma_{\text{P}}$$\end{document}ΓP is used for the frictionless sliding contact problem. Note that the Dirichlet boundary in the right figure is clipped…

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  Figure 2. Superior (left) and posterior (right) view of the atria with the considered ablation lesions in the electrophysiological domain \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\Omega_{\text{EP}}$$\end{document}ΩEP: pulmonary vein isolation (PVI), mitral isthmus line (MIL), anterior line (AL), roof line (RL), posterior box lesion (BL). The superimposed wiremesh shows the ablation lesions after mapping to the mechanical domain \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\Omega_{\text{M}}.$$\end{document}ΩM.

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  Figure 3. Activation maps and isochrones of the depolarization wave in sinus rhythm. A brown color denotes inactive tissue. The pictogram of the atria at the top of each model indicates the applied ablation lesions (red lines).

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  Figure 4. End-diastolic pressure–volume relationship (EDPVR) for the left atrium (LA), right atrium (RA), left ventricle (LV) and right ventricle (RV) for all simulations.

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  Figure 5. Blood volume traces during left atrial systole. Atrial systole lasts from the externally applied stimulation of the sinus node to the time of maximal contraction of the left atrium.

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  Figure 6. Relationship between the ablated tissue (blue squares)/inactive tissue (orange squares) and the percentage point difference in ejection fraction (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\Delta$$\end{document}ΔEP pp) with a fitted linear regression model.

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  Figure 7. Green Lagrange strain \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$E_{\text{ff}}$$\end{document}Eff in fiber direction of the Control and PVI + AL + BL case is shown in superior and anterior view during atrial and ventricular systole, respectively. Green circles mark the areas of increased/decreased strain referred to in the text.

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  Figure 8. Atrial (left column) and ventricular (right column) pressure (top row) and volume (bottom row) courses during one heart cycle. Different colors denote the simulation results of the healthy control case and all simulations including scars. Left atrium and ventricle are shown with solid lines while right atrium and ventricle are shown with dashed lines.

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  Figure 9. Left: atrioventricular valve plane displacement (AVPD) of the tricuspid valve. Center: AVPD of the mitral valve. Right: normalized blood volume in the left ventricle during one heart cycle. Different colors denote the simulation results of the healthy control case and all simulations including scars. Simulation results are compared to data from cine MRI short axis (SAX, dotted line) and long axis (LAX, dashed line) segmentations.

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  Figure 10. Simulation results of the case PVI + AL + BL for varying scar stiffness. The change in pressure and volume of the left atrium is relative to a PVI + AL + BL reference simulation with \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$2\cdot \mu$$\end{document}2·μ and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$5\cdot \alpha$$\end{document}5·α and normalized by their peak-to-peak values.

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  Figure 11. Activation time map and isochrones for the Control (a + d), the PVI + AL (b + e), and the PVI + RL (c + f) cases with a 25 and 50% reduction in conductivity.