Back UPF researchers create digital twins of the heart to conduct simulations prior to operations for arrhythmias to help minimize the risks

UPF researchers create digital twins of the heart to conduct simulations prior to operations for arrhythmias to help minimize the risks

UPF, in collaboration with Bordeaux Hospital, has generated digital twins of the heart of patients with the most common type of heart arrhythmia, atrial fibrillation. These digital twins can be used to examine the dynamics of blood flow in the patient’s heart, which until now was not known precisely and is a key element to reduce the risks of the operation.

13.11.2024

Imatge inicial - Simulations of the operation for atrial fibrillation, the most frequent arrhythmia, with which a device is placed in a specific part of the heart, inside the left atrial appendage*.

Researchers from Pompeu Fabra University (UPF) and Bordeaux Hospital have created digital twins of the heart of patients with the most common type of cardiac arrhythmia, atrial fibrillation, one of the main risk factors for blood clots and heart attacks. These digital twins enable not only knowing the morphology and blood flow of the patients’ hearts better, but also simulating different possible scenarios of the operation that some of them require, which can contribute to significantly reducing the risks. The operation consists of implanting a device in a specific part of the patient’s heart to prevent the formation of clots.

Digital twins have been created using an innovative computational method, generated by combining different existing systems. This method is a huge advancement to examine and better understand the functioning of the different types of devices that can be implanted in the patient’s heart, taking the blood flow dynamics into account, which were hitherto not precisely known, in addition to their heart morphology.

The results of the research have recently been published in a scientific article in the journal PLoS Computational Biology. The research was led by the PhySense research group of the BCN MedTech Unit of the UPF Department of Engineering, with the collaboration of the Heart Rhythm Disease Institute (IHU Liryc-CHU Bordeaux) of the University of Bordeaux.

One in five people over the age of 80 suffer from atrial fibrillation

As set out in the article, atrial fibrillation (AF) affects about 33.5 million people around the world and an estimated 5% are at risk of a heart attack. The incidence of AF is especially high among people over the age of 80, as one in five suffer from this disease.

The heart tissue of patients with AF does not perform the movements and contractions that would be normal in a healthy person so that the blood does not concentrate in an area of the heart where it should not be deposited: the so-called left atrial appendage. Blood entering this part of the heart tends to form blood clots, which can lead to a heart attack or other serious health problems.

In some cases, the heart’s poor performance can be corrected with medication. But, due to their anticoagulant effects, some patients, especially elderly ones, cannot be treated with drugs as they are contraindicated. They therefore require a surgical operation, which consists of installing a device that blocks the passage of blood to the left atrial appendage. To reduce the risks of this operation, it is crucial to choose the most appropriately shaped device for each patient’s heart anatomy (the most common are disc or plug-shaped) and for it to be placed at the most appropriate point between the left atrial appendage and the adjacent part of the heart (the left atrial cavity). It is also essential to take the particularities of each patient’s blood flow into account.

In this regard, “this method to generate digital twins of the heart will allow us to recreate more accurately than to date the anatomical conditions of each patient’s heart and above all how the blood circulates through the atrium and the left atrial appendage”, explains Carlos Albors, lead author of the research article and researcher of the UPF PhySense group. This could help physicians improve their preoperative plan, defining the most appropriate type of device for each patient and the optimal placement point. The risks of the intervention could also be substantially reduced, especially those associated with the formation of clots due to errors in device configuration.

Thirty-three possible scenarios of the operation have been simulated with 20 patients

The research team has carried out the digital twins of 20 patients with atrial fibrillation, recreating the three-dimensional structure of the heart of each of them, both before and after being operated on. These 3D recreations were made from 2D images obtained with computed tomography (CT) scans, which use X-rays, from patients at Bordeaux Hospital before and after the operation.

By means of the digital twins of the hearts of these 20 people (prior to intervention), a total of 33 simulations of the operation were carried out, combining different types of device and different placements. 3D reconstructions of the heart after the operation were used to check the extent to which the actual placement of the device was or was not optimal, compared to the ideal positions according to the simulations carried out.

A major step forward for the UPF PhySense research group towards improving the planning of atrial fibrillation operations

The UPF PhySense research group, directed by Oscar Cámara, is also behind the VIDAA platform, which allows generating virtual copies of the left atrium of patients with AF, which are useful for determining the optimal configuration of the device for each of them of them according to their heart morphology. In fact, VIDAA is one of the systems used by the method with which the new digital twins have been created, which constitutes a development of this platform. The method presented now is far more precise for examining the flow of blood between the atrium and the left atrial appendage.

Reference article: 

Albors C, Mill J, Olivares AL, Iriart X, Cochet H, Camara O (2024). Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus. PLoS Comput Biol 20(9): e1011546. https://doi.org/10.1371/journal.pcbi.1011546

 

*Additional information of the initial photo: In the first image, the placement of the device does not coincide with the boundary between the inside of the left atrium and the inside of the left atrial appendage, but is located at the deepest part of the appendage and furthest from the pulmonary vein (uncovered pulmonary ridge -UPR- position). In the second image, it does coincide with this boundary and is closer to the pulmonary vein (covered pulmonary ridge – CPR- position).