Virtual left atrial appendage occlusion in paroxysmal atrial fibrillation during sinus rhythm predicts variable reductions in blood stasis

Figures

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  Figure 1. Flow chart of the study design CT: computed tomography; LAA: left atrial appendage; CFD: computational fluid dynamics.

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  Figure 2. Definition of the flow components Residual volume stays in LA over two heartbeats. Delayed outflow enters before systole and leaves during diastole. Retained inflow enters LA during previous cardiac cycle but does not leave. Reservoir flow enters LA during systole and leaves during diastole. Pulmonary vein (PV) backflow leaves through pulmonary veins. Conduit flow enters and leaves the left atrium (LA) during diastole. Graphic was modified based on Fig. 1 originally published in Bäck et al. (2024) under CC BY 4.0.

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  Figure 3. Velocity field of the left heart Velocity field of the left heart during late atrial contraction (A‐wave of mitral valve flow) for a control subject, the AF patient with the lowest residual volume and the AF patient with the highest residual volume.

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  Figure 4. Remaining blood fraction in the left atrium Box plot of remaining blood fraction in the left atrium after 1, 2 and 3 cycles, respectively, in simulations with LAA (wLAA) and after occlusion (LAAO) for AF patients (circles) and controls (triangles). AF patient with highest residual volume from the component analysis is marked with a red diamond, AF patient with lowest residual volume is marked with red star. * P < 0.05, Wilcoxon signed rank test; ** P < 0.001, Wilcoxon signed rank test; + P < 0.05, Mann–Whitney U test; ++ P < 0.001, Mann–Whitney U test. LAA, left atrial appendage.

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  Figure 5. Volume of flow components in simulation with LAA (wLAA) and after occlusion (LAAO) Volume of flow components in simulation with LAA (wLAA) and after occlusion (LAAO) for AF patients (circles) and controls (triangles). AF patient with highest residual volume is marked with a black diamond, AF patient with lowest residual volume is marked with black star. * P < 0.05, Wilcoxon signed rank test; ** P < 0.001, Wilcoxon signed rank test; + P < 0.05, Mann–Whitney U test; ++ P < 0.001, Mann–Whitney U test. LAA, left atrial appendage; PV, pulmonary veins.

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  Figure 6. Schematic of the general position of the components at end systole and mid diastole Presented are one participant from the control group, the AF patient with lowest residual volume, and the AF patient with highest residual volume. LAA, left atrial appendage; LAAO, LAA occlusion