A computational model of fibrosis and the cardiac conduction system: the next generation of virtual heart models for research and teaching

在各种心血管疾病（CVD）中观察到纤维化的增殖，并且与心律失常（心脏的不规则节律）有关。然而，纤维化促进心律失常的确切机制尚未完全了解。目前纤维化的计算模型缺乏复杂性，未能捕获潜在的电异质性。开发先进的纤维化计算模型将使详细的模拟研究成为可能，并揭示新的机制见解。此外，心脏传导系统（CCS）控制心脏的正常兴奋，其重塑可直接导致心律失常。然而，很少，如果有的话，计算模型纳入详细的电生理解剖表示的CCS由于成像和分割这个系统的解剖data.Atrial颤动（AF），最普遍的持续性心律失常的挑战，变得越来越具有挑战性的治疗和管理，因为它进展到一个慢性条件，与电和结构重塑。纤维化在这一进展中起着重要作用，特别是在慢性AF中出现复杂的兴奋模式时。CCS在电兴奋从心房到心室的传输中至关重要，使其成为了解AF如何损害心脏功能的关键因素。为了支持未来改进的诊断和治疗策略，了解纤维化和CCS在AF发展和进展中的作用是至关重要的。该项目旨在开发一种新的纤维化计算模型，并将其与CCS集成到一个全面的全心脏模型中。由此产生的工具将支持未来的无动物研究，并将应用于他的项目，以解决有关AF机制的基本问题。该项目汇集了一个计算建模师和实验学家团队，拥有丰富的模型，数据和经验，以实现其目标：目标1：开发和验证详细和特定的模型，整合不同形式纤维化的电生理和解剖特征，目的2：使用所开发的模型研究纤维化促进心律失常触发和基质的基本机制。目的3：通过将模型与重建的人类心房和纤维化图一起应用，探索纤维化如何促进AF的触发和基质。目的4：将这些模型集成到我们的全心脏模型中，并开发一个强大的模拟，能够考虑结构重塑和模拟正常和异常的激活patterns.Objective 5：调查AF之间的相互作用，CCS，心室功能使用全面的全心脏模型。

The proliferation of fibrosis is observed in various cardiovascular diseases (CVDs) and has been linked to arrhythmias, the irregular rhythm of the heart. However, the precise mechanisms through which fibrosis promotes arrhythmia are not yet fully understood. Current computational models of fibrosis lack sophistication, failing to capture the underlying electrical heterogeneity. Developing an advanced computational model of fibrosis would enable detailed simulation studies and reveal novel mechanistic insights. Additionally, the cardiac conduction system (CCS) governs the normal excitation of the heart, and its remodelling can directly lead to arrhythmias. However, few, if any, computational models incorporate detailed electrophysiologically-anatomical representations of the CCS due to challenges in imaging and segmenting this system from anatomical data.Atrial fibrillation (AF), the most prevalent sustained cardiac arrhythmia, becomes increasingly challenging to treat and manage as it progresses to a chronic condition, associated with electrical and structural remodelling. Fibrosis plays a significant role in this progression, particularly in the emergence of complex excitation patterns in chronic AF. The CCS is critical in the transmission of electrical excitation from the atria to the ventricles, making it a crucial factor in understanding how AF impairs cardiac function.To underpin improved diagnostic and treatment strategies in the future, understanding the roles of fibrosis and the CCS in the development and progression of AF is essential. This project aims to develop a novel computational model of fibrosis, integrating it into a comprehensive whole-heart model with the CCS. The resulting tool will support future animal-free research and will be applied in his project to address fundamental questions regarding the mechanisms of AF.The project brings together a team of computational modellers and experimentalists with a wealth of models, data, and experience to deliver on its objectives:Objective 1: Develop and validate detailed and specific models that integrate electrophysiological and anatomical features of different forms of fibrosis, building upon our novel approach for modelling heterogeneous cellular coupling.Objective 2: Investigate the fundamental mechanisms by which fibrosis promotes arrhythmia triggers and substrate using the developed model.Objective 3: Explore how fibrosis contributes to trigger and substrate in AF by applying the models alongside reconstructed human atria and fibrosis maps.Objective 4: Integrate these models into our whole-heart model and develop a robust simulation capable of considering structural remodelling and simulating normal and abnormal activation patterns.Objective 5: Investigate the interaction between AF, the CCS, and ventricular function using the comprehensive whole-heart model.