Sensitivity Analysis of In Silico Fluid Simulations to Predict Thrombus Formation after Left Atrial Appendage Occlusion

Jordi Mill, Victor Agudelo, Andy L. Olivares, Maria Isabel Pons, Etelvino Silva, Marta Nuñez-Garcia, Xabier Morales, Dabit Arzamendi, Xavier Freixa, Jérôme Noailly and Oscar Camara
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Jordi Mill: BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018 Barcelona, Spain
Victor Agudelo: Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
Andy L. Olivares: BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018 Barcelona, Spain
Maria Isabel Pons: BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018 Barcelona, Spain
Etelvino Silva: Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Grupo GADICOR, Hospital Universitario Puerta del Mar, Universidad de Cádiz, 11009 Cádiz, Spain
Marta Nuñez-Garcia: Electrophysiology and Heart Modeling Institute (IHU Liryc), 33600 Pessac, France
Xabier Morales: BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018 Barcelona, Spain
Dabit Arzamendi: Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
Xavier Freixa: Department of Cardiology, Hospital Clínic, 08036 Barcelona, Spain
Jérôme Noailly: BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018 Barcelona, Spain
Oscar Camara: BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018 Barcelona, Spain

Mathematics, 2021, vol. 9, issue 18, 1-19

Abstract: Atrial fibrillation (AF) is nowadays the most common human arrhythmia and it is considered a marker of an increased risk of embolic stroke. It is known that 99% of AF-related thrombi are generated in the left atrial appendage (LAA), an anatomical structure located within the left atrium (LA). Left atrial appendage occlusion (LAAO) has become a good alternative for nonvalvular AF patients with contraindications to anticoagulants. However, there is a non-negligible number of device-related thrombus (DRT) events, created next to the device surface. In silico fluid simulations can be a powerful tool to better understand the relation between LA anatomy, haemodynamics, and the process of thrombus formation. Despite the increasing literature in LA fluid modelling, a consensus has not been reached yet in the community on the optimal modelling choices and boundary conditions for generating realistic simulations. In this line, we have performed a sensitivity analysis of several boundary conditions scenarios, varying inlet/outlet and LA wall movement configurations, using patient-specific imaging data of six LAAO patients (three of them with DRT at follow-up). Mesh and cardiac cycle convergence were also analysed. The boundary conditions scenario that better predicted DRT cases had echocardiography-based velocities at the mitral valve outlet, a generic pressure wave from an AF patient at the pulmonary vein inlets, and a dynamic mesh approach for LA wall deformation, emphasizing the need for patient-specific data for realistic simulations. The obtained promising results need to be further validated with larger cohorts, ideally with ground truth data, but they already offer unique insights on thrombogenic risk in the left atria.

Keywords: sensitivity analysis; boundary conditions; computational fluid dynamics; dynamic mesh; device-related thrombus; left atrium; left atrial appendage (search for similar items in EconPapers)
JEL-codes: C (search for similar items in EconPapers)
Date: 2021
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