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Changes in Global and Regional Mechanics Due to Atrial Fibrillation: Insights from a Coupled Finite-Element and Circulation Model

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Abstract

Atrial fibrillation (AF) is a rhythm disorder with rapidly increasing prevalence due to the aging of the population. AF triggers structural remodeling and a gradual loss of function; however, the relative contributions of specific features of AF-induced remodeling to changes in atrial mechanical function are unclear. We constructed and validated a finite-element model (FEM) of the normal human left atrium using anatomic information from cardiac magnetic resonance imaging, material properties and fiber orientations from published studies, and an iterative algorithm to estimate unloaded geometry. We coupled the FEM to a circuit model to capture hemodynamic interactions between the atrium, pulmonary circulation, and left ventricle. The normal model reproduced measured volumes within 1 SD, as well as most metrics of regional mechanics. Using this validated human model as a starting point, we explored the impact of individual features of atrial remodeling on atrial mechanics and found that a combination of dilation, increased pressure, and fibrosis can explain most of the observed changes in mechanics in patients with paroxysmal AF. However, only impaired ventricular relaxation could reproduce the increased reliance on active emptying we observed in these patients. The resulting model provides new insight into the mechanics of AF and a platform for exploring future therapies.

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Acknowledgments

The authors wish to thank Dr. David Lopez for processing atrial MRI and pressure–volume loops. This work was supported in part by a Pre-Doctoral Fellowship (Christian Moyer) and an Established Investigator Award (Jeffrey Holmes) from the AHA, and NIH/NHLBI R01 HL-085160 (Jeffrey Holmes).

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Authors and Affiliations

  1. Department of Biomedical Engineering, University of Virginia, P.O Box 800759, Charlottesville, VA, 22908, USA

    Christian B. Moyer & Jeffrey W. Holmes

  2. Department of Medicine, University of Virginia, Charlottesville, VA, USA

    John D. Ferguson & Jeffrey W. Holmes

  3. Department of Radiology, University of Virginia, Charlottesville, VA, USA

    Patrick T. Norton

  4. Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA

    Jeffrey W. Holmes

Authors
  1. Christian B. Moyer
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  2. Patrick T. Norton
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  4. Jeffrey W. Holmes
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Correspondence to Jeffrey W. Holmes.

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Associate Editor Estefanía Peña oversaw the review of this article.

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Moyer, C.B., Norton, P.T., Ferguson, J.D. et al. Changes in Global and Regional Mechanics Due to Atrial Fibrillation: Insights from a Coupled Finite-Element and Circulation Model. Ann Biomed Eng 43, 1600–1613 (2015). https://doi.org/10.1007/s10439-015-1256-0

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  • DOI: https://doi.org/10.1007/s10439-015-1256-0

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