A Comparison of Fiber Based Material Laws for Myocardial Scar

Personalized biomechanical insights in atrial fibrillation: opportunities & challenges

INTRODUCTION

Atrial fibrillation (AF) is an increasingly prevalent and significant worldwide health problem. Manifested as an irregular atrial electrophysiological activation, it is associated with many serious health complications. AF affects the biomechanical function of the heart as contraction follows the electrical activation, subsequently leading to reduced blood flow. The underlying mechanisms behind AF are not fully understood, but it is known that AF is highly correlated with the presence of atrial fibrosis, and with a manifold increase in risk of stroke.

AREAS COVERED

In this review, we focus on biomechanical aspects in atrial fibrillation, current and emerging use of clinical images, and personalized computational models. We also discuss how these can be used to provide patient-specific care.

EXPERT OPINION

Understanding the connection betweenatrial fibrillation and atrial remodeling might lead to valuable understanding of stroke and heart failure pathophysiology. Established and emerging imaging modalities can bring us closer to this understanding, especially with continued advancements in processing accuracy, reproducibility, and clinical relevance of the associated technologies. Computational models of cardiac electromechanics can be used to glean additional insights on the roles of AF and remodeling in heart function.

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

PURPOSE

Atrial fibrillation is one of the most frequent cardiac arrhythmias in the industrialized world and ablation therapy is the method of choice for many patients. However, ablation scars alter the electrophysiological activation and the mechanical behavior of the affected atria. Different ablation strategies with the aim to terminate atrial fibrillation and prevent its recurrence exist but their impact on the performance of the heart is often neglected.

METHODS

In this work, we present a simulation study analyzing five commonly used ablation scar patterns and their combinations in the left atrium regarding their impact on the pumping function of the heart using an electromechanical whole-heart model. We analyzed how the altered atrial activation and increased stiffness due to the ablation scars affect atrial as well as ventricular contraction and relaxation.

RESULTS

We found that systolic and diastolic function of the left atrium is impaired by ablation scars and that the reduction of atrial stroke volume of up to 11.43% depends linearly on the amount of inactivated tissue. Consequently, the end-diastolic volume of the left ventricle, and thus stroke volume, was reduced by up to 1.4 and 1.8%, respectively. During ventricular systole, left atrial pressure was increased by up to 20% due to changes in the atrial activation sequence and the stiffening of scar tissue.

CONCLUSION

This study provides biomechanical evidence that atrial ablation has acute effects not only on atrial contraction but also on ventricular performance. Therefore, the position and extent of ablation scars is not only important for the termination of arrhythmias but is also determining long-term pumping efficiency. If confirmed in larger cohorts, these results have the potential to help tailoring ablation strategies towards minimal global cardiovascular impairment.

Computationally Efficient Concept of Representative Directions for Anisotropic Fibrous Materials

The concept of representative directions allows for automatic generation of multi-axial constitutive equations, starting from simplified uni-axial material models. In this paper, a modification of the concept is considered suitable for the analysis of fibrous polymeric materials, which are anisotropic in the as-received state. The modification of the concept incorporates an orientation probability density function (OPDF), which explicitly accounts for the material anisotropy. Two versions of the concept are available. The first version utilizes the homogeneous distribution of the representative directions, with the entire anisotropy being contained in the weighting factors. The second encapsulates the anisotropy in the distribution of the representative directions. Due to its nature, the second version allows for a more efficient use of computational power. To promote this efficient version of the concept, we present new algorithms generating required sets of representative directions that match a given OPDF. These methods are based (i) on the minimization of a potential energy, (ii) on the equilibration method, and (iii) on the use of Voronoi cells. These three methods are tested and compared in terms of various OPDFs. The applicability of the computationally efficient modeling method to mechanical behavior of an anisotropic polymeric material is demonstrated. In particular, a calibration procedure is suggested for the practically important case when the OPDF is not known a-priori.