Procedure description

Project leader Universitat Pompeu Fabra (UPF)

The objective is to generate in-silico personalised haemodynamic indices of left atrial geometries, complementing their morphological analysis, to identify the risk of thrombus formation in atrial fibrillation patients, improve patient selection for the implantation of LAAO and optimise their settings (e.g. size, positioning).

This study covers in-silico fluid simulations, which are already a prerequisite in stent validation and certification. However, fluid simulations including more complex medical devices such as implantable devices were, until recently, not mature enough to be part of regulatory submissions. For LAAO devices, fluid simulations need common standards, best practices, sensitivity analyses and model calibration to determine the optimal set of boundary conditions to match experimental results.

This work will develop robust computational pipelines to process the large amount of data required for in-silico clinical trials. We will model the entire cycle of care for these patients, including patterns of thrombus formation and drug treatment, for improved patient selection, personalisation of device settings, and prediction of treatment response.

Computational fluid dynamic and Left atrial modelĀ  @UPF

Course of action

  1. Development of computational pipeline for generating patient-specific meshes and patient-specific boundary conditions for large number of cases.
  2. Sensitivity analyses and model calibration to determine optimal methodological choices in fluid simulations.
  3. Verification and validation (V&V) studies to assess the credibility of the developed models.
  4. Derivation of in-silico haemodynamic indices to assess the risk of thrombus formation and predict the benefit of LAAO implantation.
  5. Optimisation of LAAO settings to minimise the risk of device-related thrombus in combination with appropriate drug therapy.

Demonstration of interactive tool for LAAO device setting selection

The video demonstrates the use of the VIDAA (Virtual Implantation and Device selection for left Atrial Appendages) platform, a web-based interface where the user can jointly visualise the 3D anatomy of the left atria and several morphological indices such as the diameters of the ostium and along the LAA centreline. Based on the LA morphological characterisation, the platform provides some recommended sizes for different types of LAAO devices (e.g., plug- and pacifier-type), but the user can select any device configuration. Once a LAAO device is selected, the user can interactively place it in different locations to study the optimal settings for the analysed LA geometry, including independent manipulation of different device parts. Finally, the VIDAA platform performs a virtual device deployment to predict how the device will fit the LA wall, showing the degree of device compression in a colourmap. The desired LAAO device configuration can then be exported so that fluid simulations can be run in the Cloud to compute haemodynamic in-silico indices estimating the risk of device-related thrombus.