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Register a new userMechanisms of stochastic onset and termination of atrial fibrillation episodes: Insights using a cellular automaton model
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Mathematical models of cardiac electrical excitation are increasingly complex, with multiscale models seeking to represent and bridge physiological behaviours across temporal and spatial scales. The increasing complexity of these models makes it computationally expensive to both evaluate long term (>60 seconds) behaviour and determine sensitivity of model outputs to inputs. This is particularly relevant in models of atrial fibrillation (AF), where individual episodes last from seconds to days, and inter-episode waiting times can be minutes to months. Potential mechanisms of transition between sinus rhythm and AF have been identified but are not well understood, and it is difficult to simulate AF for long periods of time using state-of-the-art models. In this study, we implemented a Moe-type cellular automaton on a novel, topologically correct surface geometry of the left atrium. We used the model to simulate stochastic initiation and spontaneous termination of AF, arising from bursts of spontaneous activation near pulmonary veins. The simplified representation of atrial electrical activity reduced computational cost, and so permitted us to investigate AF mechanisms in a probabilistic setting. We computed large numbers (~10^5) of sample paths of the model, to infer stochastic initiation and termination rates of AF episodes using different model parameters. By generating statistical distributions of model outputs, we demonstrated how to propagate uncertainties of inputs within our microscopic level model up to a macroscopic level. Lastly, we investigated spontaneous termination in the model and found a complex dependence on its past AF trajectory, the mechanism of which merits future investigation.
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Atrial fibrillation (AF) is a leading cause of morbidity and mortality. AF prevalence increases with age, which is attributed to pathophysiological changes that aid AF initiation and perpetuation. Current state-of-the-art models are only capable of simulating short periods of atrial activity at high spatial resolution, whilst the majority of clinical recordings are based on infrequent temporal datasets of limited spatial resolution. Being able to estimate disease progression informed by both modelling and clinical data would be of significant interest. In addition an analysis of the temporal distribution of recorded fibrillation episodes AF density can provide insights into recurrence patterns. We present an initial analysis of the AF density measure using a simplified idealised stochastic model of a binary time series representing AF episodes. The future aim of this work is to develop robust clinical measures of progression which will be tested on models that generate long-term synthetic data. These measures would then be of clinical interest in deciding treatment strategies.
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