In-silico analysis of the influence of pulmonary vein configuration on left atrial haemodynamics and thrombus formation in a large cohort

TL;DR

This study uses computational fluid dynamics to analyze how pulmonary vein configurations affect left atrial blood flow and thrombus risk in atrial fibrillation, based on the largest patient cohort to date.

Contribution

It provides new insights into the influence of pulmonary vein orientation and LAA shape on atrial haemodynamics using in-silico simulations of 52 patients.

Findings

Right pulmonary vein height and angulation significantly affect LA haemodynamics.

Certain LAA shapes with high bending promote flow stagnation.

Largest cohort in literature for in-silico atrial flow analysis.

Abstract

Atrial fibrillation (AF) is considered the most common human arrhythmia. Around 99\% of thrombi in non-valvular AF are formed in the left atrial appendage (LAA). Studies suggest that abnormal LAA haemodynamics and the subsequently stagnated flow are the factors triggering clot formation. However, the relation between LAA morphology, the blood pattern and the triggering is not fully understood. Moreover, the impact of structures such as the pulmonary veins (PVs) on LA haemodynamics has not been thoroughly studied due to the difficulties of acquiring appropriate data. On the other hand, in-silico studies and flow simulations allow a thorough analysis of haemodynamics, analysing the 4D nature of blood flow patterns under different boundary conditions. However, the reduced number of cases reported on the literature of these studies has been a limitation. The main goal of this work was to study the influence of PVs on left atrium (LA) and LAA haemodynamics. Computational fluid dynamics simulations were run on 52 patients, the largest cohort so far in the literature, where different parameters were individually studied: pulmonary veins orientation and configuration; LAA and LA volumes and its ratio; and flow velocities. Our computational analysis showed how the right pulmonary vein height and angulation have a great influence on LA haemodynamics. Additionally, we found that LAA with great bending with its tip pointing towards the mitral valve could contribute to favour flow stagnation.