Geometric analysis on the unidirectionality of the pulmonary veins for atrial reentry

TL;DR

This paper introduces a geometric analysis method to understand how the pulmonary veins contribute to atrial reentry and atrial fibrillation, validated through computational models and simulations.

Contribution

It develops a novel geometric relative acceleration analysis adapted from spacetime physics to explain conduction failure at pulmonary veins.

Findings

Unidirectionality of pulmonary veins is confirmed.

Propagation direction and anisotropy influence conduction failure.

Validated by computational models and previous in-silico studies.

Abstract

It is widely believed that the pulmonary veins (PVs) of the atrium play the central role in the generation of atrial reentry leading to atrial fibrillation, but its mechanism has not been analytically explained. In order to improve the current clinical procedures for atrial reentry by understanding its mechanism, geometrical analysis is proposed on the conditions of conduction failure at the PVs and is validated by various computational modeling. To achieve this, a new analytic approach is proposed by adapting the geometric relative acceleration analysis from spacetime physics on the hypothesis that a large relative acceleration can translate to a dramatic increase in the curvature of the wavefront and subsequently to conduction failure. This analytic method is applied to a simplified model of the PV to reveal the strong dependency of the propagational direction and the magnitude of anisotropy for conduction failure. The unidirectionality of the PVs follows directly and is validated by computational tests in a T-shaped domain, computational simulations for three-dimensional atrial reentry and previous in-silico reports for atrial reentry.