title: Towards personalized computational modelling of the fibrotic substrate for atrial arrhythmia.
abstract: : Atrial arrhythmias involving a fibrotic substrate are an important cause of morbidity and mortality. In many cases, effective treatment of such rhythm disorders is severely hindered by a lack of mechanistic understanding relating features of fibrotic remodelling to dynamics of re-entrant arrhythmia. With the advent of clinical imaging modalities capable of resolving the unique fibrosis spatial pattern present in the atria of each individual patient, a promising new research trajectory has emerged in which personalized computational models are used to analyse mechanistic underpinnings of arrhythmia dynamics based on the distribution of fibrotic tissue. In this review, we first present findings that have yielded a robust and detailed biophysical representation of fibrotic substrate electrophysiological properties. Then, we summarize the results of several recent investigations seeking to use organ-scale models of the fibrotic human atria to derive new insights on mechanisms of arrhythmia perpetuation and to develop novel strategies for model-assisted individualized planning of catheter ablation procedures for atrial arrhythmias.
authors.affiliation: Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, 3400 N Charles St, 208 Hackerman Hall, Baltimore, MD 21218, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Boyle
authors.affiliation: Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, 3400 N Charles St, 208 Hackerman Hall, Baltimore, MD 21218, USA.
authors.forename: Sohail
authors.initials: S
authors.lastname: Zahid
authors.affiliation: Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, 3400 N Charles St, 208 Hackerman Hall, Baltimore, MD 21218, USA ntrayanova@jhu.edu.
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Trayanova
mesh_terms: D000200:Action Potentials; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D001282:Atrial Flutter / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D016275:Atrial Function; D064752:Atrial Remodeling; D057791:Cardiac Imaging Techniques; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005355:Fibrosis; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D021621:Imaging, Three-Dimensional; D008955:Models, Cardiovascular; D066230:Patient-Specific Modeling; D011237:Predictive Value of Tests
keywords: Atrial fibrillation; Atrial flutter; Computational modelling; Fibrotic remodelling