Simulation Optimization for Reconstructing Rhythmic Mechanisms in Atrial Fibrillation

Atrial Fibrillation (AF) is a common cardiac arrhythmia that affects more than 5 million Americans. The impact of AF on healthcare systems is overwhelming, due to high risk of stroke, increased mortality, impaired quality of life and hospitalization. Catheter ablation is an established treatment for AF. During the procedure, physicians use the electrodes at the end of catheters to record electrical activity in the atria (i.e., intracardiac electrogram). Further, cardiologists pinpoint the potential AF sources and deliver energy through the catheter to create incision lines that block faulty electrical pathways. However, the understanding of AF initiation and maintenance has remained sketchy at best. One salient problem is the inability to interpret intracardiac recordings, which have thus far been unable to reconstruct the rhythmic mechanisms for AF. As a result, physicians often need to make ablation decisions using ad hoc or heuristic strategies. There is an urgent need to realize the full potentials of intracardiac electrograms for optimizing ablation decisions. The objective of this chapter is to develop and calibrate computer models of human atria to simulate fibrillatory conductions that replicate the patterns in clinical recordings. This research will accelerate the knowledge discovery in the initiation and perpetuation of AF. The research outcomes will positively impact cardiovascular patients, the largest population at risk of death in the world.