Unified mechanism of local drivers in a percolation model of atrial fibrillation
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
The mechanisms of atrial fibrillation (AF) are poorly understood, resulting in disappointing success rates of ablative treatment. Different mechanisms defined largely by different atrial activation patterns have been proposed and, arguably, this dispute has slowed the progress of AF research. Recent clinical evidence suggests a unifying mechanism of local drivers based on sustained re-entrant circuits in the complex atrial architecture. Here, we present a percolation inspired computational model showing spontaneous emergence of AF that strongly supports, and gives a theoretical explanation for, the clinically observed diversity of activation. We show that the difference in surface activation patterns is a direct consequence of the thickness of the discrete network of heart muscle cells through which electrical signals percolate to reach the imaged surface. The model naturally follows the clinical spectrum of AF spanning sinus rhythm, paroxysmal and persistent AF as the decoupling of myocardial cells results in the lattice approaching the percolation threshold. This allows the model to make the novel prediction that for paroxysmal AF, re-entrant circuits emerge near the endocardium, but in persistent AF they emerge deeper in the bulk of the atrial wall. If experimentally verified, this may go towards explaining the lowering ablation success rate as AF becomes more persistent.
Date Issued
2019-12-09
Date Acceptance
2019-10-16
Citation
Physical Review E, 2019, 100 (6)
ISSN
2470-0045
Publisher
American Physical Society
Journal / Book Title
Physical Review E
Volume
100
Issue
6
Copyright Statement
Published by the American Physical Society under the terms of the Creative Commons Attribution 4.0 International license. Further distribution of this work must maintain attribution to the author(s) and the published article's title, journal citation, and DOI.
Sponsor
Rosetrees Trust
British Heart Foundation
British Heart Foundation
British Heart Foundation
British Heart Foundation
Rosetrees Trust
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Grant Number
A1173/ M577
RG/16/3/32175
EPSRC DTP, award ref. EP/N509486/1
RE/18/4/34215
PG/16/17/32069
PG/16/17/32069
A1407/ M645
RDB02
RDB02
Publication Status
Published
Article Number
062406