Computational analysis of virtual ablation or fast conduction pathways insertion in a 2-dimensional atrial tissue

Atrial Fibrillation (AF) is a common and challenging arrhythmia in clinical practice. There are some consolidated ways of interventions to treat it, i.e. antiarrhythmic drugs and catheter ablation, but each of them has its own limitations. Indeed, the first can become paradoxically pro-arrhythmic, while the second may have large disruptive effects and it struggles to create durable lesions in the correct sites. This study aimed to evaluate two alternative approaches to terminate AF, basing on the understanding of the underlying mechanisms of development and sustainment of AF. The first approach considered is Targeted Ablation, which aims to target specific heart's areas, thus ensuring less ‘hitten mass’ in cardiac walls. Computational simulations on AF remodeled tissue segments were implemented to test targeted ablation’s efficacy, applying also spiral wave reentries, or rotors. The second approach is proposed for the first time in this work and it involves inserting a patch into the tissue, that is already clinically used to treat conditions like myocardial infarction. The patch was modified and employed to carry out a different purpose, i.e. creating a fast conduction pathway for the electrical signal within fibrillating regions, aiming to synchronize tissue activation. Results showed that targeted ablation effectively anchored rotors, converting fibrillation into tachycardia; while, with some particular conditions, it eliminates the rotors at all. Whereas the patch manage to stop rotor activity at varying intervals, depending on the properties given to it. This latter approach is very promising, but requires further refinement, particularly concerning patch modeling and its tissue impact.