TY - CHAP
T1 - Left Atrial Appendage Morphology Impacts Thrombus Formation Risks in Multi-Physics Atrial Models
AU - Qureshi, Ahmed
AU - Balmus, Maximilian
AU - Nechipurenko, Dmitry
AU - Ataullakhanov, Fazoil
AU - Williams, Steven
AU - Lip, Gregory
AU - Nordsletten, David
AU - Aslanidi, Oleg
AU - De Vecchi, Adelaide
N1 - Funding Information:
This research was supported by the EPSRC [EP/R513064/1].
Publisher Copyright:
© 2021 Creative Commons.
PY - 2021
Y1 - 2021
N2 - Atrial fibrillation (AF) is a major cause of stroke and there has been much interest in the underlying mechanisms leading to this higher risk of thrombus formation. The latter risk correlates with four morphologies of the left atrial appendage (LAA), i.e. chicken wing (CW), broccoli (BR), cactus (CA) and windsock (WS). We present a mechanistic study of coagulation dynamics in blood flow in a series of 2D models of the left atrium (LA) to dissect the impact of LAA shape on thrombus formation. Interactions between blood flow, viscosity and key clotting proteins (thrombin, fibrinogen and fibrin) were modelled during 1 minute of pulsatile LA blood flow to simulate the blood gelification process leading to thrombus formation. Simulations were performed in sinus rhythm (SR) and AF by varying the active contraction of the LAA and pulmonary vein inflow velocities. In the CW morphology, fibrin inside the LAA was almost completely washed out after 28 seconds in SR, while in AF the gelification process was slow, suggesting the CW has the lowest risk of thrombus formation. Conversely, the BR morphology had the highest risk of thrombus formation due to a region of sustained flow stasis which prevented fibrin washout during SR and facilitated the shortest time to thrombus formation in AF.
AB - Atrial fibrillation (AF) is a major cause of stroke and there has been much interest in the underlying mechanisms leading to this higher risk of thrombus formation. The latter risk correlates with four morphologies of the left atrial appendage (LAA), i.e. chicken wing (CW), broccoli (BR), cactus (CA) and windsock (WS). We present a mechanistic study of coagulation dynamics in blood flow in a series of 2D models of the left atrium (LA) to dissect the impact of LAA shape on thrombus formation. Interactions between blood flow, viscosity and key clotting proteins (thrombin, fibrinogen and fibrin) were modelled during 1 minute of pulsatile LA blood flow to simulate the blood gelification process leading to thrombus formation. Simulations were performed in sinus rhythm (SR) and AF by varying the active contraction of the LAA and pulmonary vein inflow velocities. In the CW morphology, fibrin inside the LAA was almost completely washed out after 28 seconds in SR, while in AF the gelification process was slow, suggesting the CW has the lowest risk of thrombus formation. Conversely, the BR morphology had the highest risk of thrombus formation due to a region of sustained flow stasis which prevented fibrin washout during SR and facilitated the shortest time to thrombus formation in AF.
UR - http://www.scopus.com/inward/record.url?scp=85124745718&partnerID=8YFLogxK
U2 - 10.23919/CinC53138.2021.9662901
DO - 10.23919/CinC53138.2021.9662901
M3 - Conference paper
AN - SCOPUS:85124745718
T3 - Computing in Cardiology
BT - 2021 Computing in Cardiology, CinC 2021
PB - IEEE Computer Society
T2 - 2021 Computing in Cardiology, CinC 2021
Y2 - 13 September 2021 through 15 September 2021
ER -