Clinical insights into atrial fibrillation pathology and management using four-chamber electromechanical heart models

Atrial fibrillation (AF) is the most common type of heart rhythm disturbance and is characterised by a chaotic, irregular atrial rhythm. Treatment strategies for AF fall into two distinct categories:

Rate control strategies aim to decrease the ventricular rate to within healthy ranges. This can be achieved either pharmaceutically (with beta-blockers, for example) or surgically by ablating the atrioventricular node and implanting a pacing lead.

Rhythm control strategies aim to restore sinus rhythm. This can also be achieved either pharmaceutically using anti-arrhythmic drugs or surgically (with a pulmonary vein isolation, for example).

Despite several large randomised clinical trials in recent decades, there is still no consensus on the optimal treatment strategy for AF. Several studies (AFFIRM, STAF, RACE II, HOT CAFE, PIAF) have found that rate control was equally as effective as rhythm control and was associated with fewer adverse effects. Meanwhile, other studies (EAST-AFNET 4, CABANA, CASTLE-AF) have suggested that rhythm control is more effective at reducing mortality and improving quality of life.

This project will use computational electro-mechanical modelling to investigate the biomechanics of AF. Specifically, this project aims to complete a factorial study of the effects of AF characteristics (fast heart rate, irregular heart rate, lack of atrial contraction) on left ventricular (LV) function. This will allow the individual and synergistic effects of AF characteristics on LV function to be investigated and could contribute to clinical understanding of rate and rhythm control strategies.