High-resolution Decryption of Left Atrial Haemodynamics in Atrial Fibrillation (HiDDyn-AF)

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Atrial fibrillation (AF) is characterized by disorganized atrial electrical activation leading to a rapid and irregular heart rate. Incidence rates are rising to epidemic levels with aging populations. AF disrupts left atrium (LA) fluid dynamics, increasing the risk of stroke and catheter ablation seeks to restore sinus rhythm. We aim to develop of personalised risk stratification in AF patients, begin to optimise ablation treatment and generate novel findings about the pathophysiology of AF. High-resolution Decryption of Left Atrial Haemodynamics in AF (HiDDyn-AF) adopts a cross-disciplinary approach to combine computational fluid dynamics (CFD), 4D flow MRI, late-gadolinium enhancement MRI and computed tomography to create a novel model of LA flow. This model will be applied to investigate AF patients pre- and post-ablation. Furthermore, LA flow will be compared with myocardial fibrosis and strain. Previously, LA flow has been modelled in small groups with idealised or patient-specific geometries. Some applied wall motion however none have been validated with 4D flow MRI as planned in HIDDyn-AF. The project will further extend the state-of-the-art by analysing many more cases than previous studies (N=50), to produce impactful results. The research questions are built on the complimentary experience of the host team, clinical collaborators, secondment team and the applicant. Accordingly, the objectives are to: develop a novel, high-resolution, validated model of LA flow (O1), define LA haemodynamics (vortices, WSS and turbulence) for AF (O2) and determine: the haemodynamic impact of ablation (O3), if haemodynamics predict recurrence of AF (<1 yr) (O4), if a relationship exists between LA myocardial fibrosis (O5), myocardial strain (O6) and haemodynamics. HiDDyn-AF consists of 6 work packages: project management, knowledge transfer & training, model development study, large cohort study of pre- & post-ablation patients, analysis & synthesis and dissemination.