Personalised thermal-fluid models for planning catheter ablation therapy for atrial arrhythmia

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In recent years, significant advances in clinical imaging have provided a wealth of detailed information on the internal function and anatomy of the human body. Fundamental questions on the progression of diseases and on their treatment can be addressed using this information. A highly promising avenue for the exploitation of this potential is the creation of biophysical computer models of the organs based on these state-of-the-art data. These models combine the available clinical information in a consistent mathematical framework that can be tailored to the specific characteristics of the individual patient. They can be used to predict the complex internal dynamics of a working organ, as well as its diseases' mechanisms, providing a powerful tool to personalise treatment. This project will create a toolbox to generate personalised models of flow and temperature in the heart. Specifically, this platform will be designed to simulate atrial fibrillation, a disease that commonly affects one chamber of the heart (the left atrium), and its treatment, known as catheter ablation. When the left atrium is in fibrillation, the wall stops contracting and starts quivering. This behavior is triggered by abnormal electrical impulses at a specific site, called the driver site. As a result, the motion of the blood flow in the atrium is weakened. This abnormal behavior can reduce the supply of blood to the body. Catheter ablation consists in burning the driver site in the atrial wall by applying heat via a catheter, in order to suppress the abnormal electrical impulses and restore contraction. However, patient outcomes are suboptimal and reoccurrence of fibrillation after a single procedure is high. This is due to the strong dependence of this treatment effectiveness on patient-specific factors that are difficult to quantify from the imaging data alone.The proposed research will focus on improving outcomes using personalised computer models. Previous pilot work has proven the potential of this type of approach in predicting the size of the lesion caused by ablation. The overall goal of this project is to create physiologically accurate, personalised models to inform the choice of the ablation parameters such as the catheter voltage and the ablation time. This modelling toolbox will then be applied to a cohort of patients with the aim of increasing significantly the clinical impact of the approach. The research will be undertaken at St Thomas' Hospital, one of the biggest UK referral centres for atrial fibrillation. Given the multi-disciplinary aspect of the project, internal collaborations have been set up with groups within different areas of expertise. Clinical guidance and patient datasets will be provided by Dr M. O'Neill and his team, the Cardiac Arrhythmia Research Group, while Dr O. Aslanidi and Dr D. Nordsletten will provide expertise in scar and blood flow modelling, respectively. This work will therefore generate impact in different areas, from clinical research to mathematical modelling. Ultimately, however, the beneficiaries of the proposed project are the patients themselves, who will benefit from a personalised and more efficient approach to catheter ablation.