Anatomically-Induced Fibrillation in a 3D Model of the Human Atria

Atrial fibrillation (AF) requires both a trigger and a substrate that can maintain a complex reentrant activity. In patients and in experimental models this substrate is provided by both electrical and structural remodeling. Since these processes overlap in time it is impossible to assess their individual contributions to AF maintenance experimentally. Therefore we studied the effect of electrical remodeling alone on AF initiation in a realistic numerical model of the human atria. We attempted to initiate AF by rapid pacing in 10 different locations, both with and without electrical remodeling. The protocols were repeated twice, with small variations in calcium conductivity, so that in total 30 simulations with and 30 simulations without remodeling were performed. In models with electrical remodeling, functional conduction block at structural inhomogeneities induced AF in 27% of the simulations. In models without electrical remodeling, AF could not be induced. We conclude that in the complex anatomy of the atria electrical remodeling alone increases the probability of AF substantially. This finding supports a mechanism whereby electrical remodeling, which occurs relatively fast, accelerates the slower but irreversible structural remodeling process.