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Impaired coronary blood flow at higher heart rates during atrial fibrillation: Investigation via multiscale modelling

S Scarsoglio1, C Gallo1, A Saglietto2

  • 1Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy.

Computer Methods and Programs in Biomedicine
|May 21, 2019
PubMed

Insights

Atrial fibrillation (AF) at higher ventricular rates impairs coronary blood flow and myocardial oxygen balance. Coronary perfusion is significantly reduced above 90-110 beats per minute (bpm) during AF.

Area of Science:

  • Cardiovascular Physiology
  • Computational Fluid Dynamics
  • Medical Simulation

Background:

  • Atrial fibrillation (AF) is linked to coronary flow impairment, but the hemodynamics are not fully understood.
  • Existing research lacks clarity on how ventricular rate during AF impacts coronary perfusion.
  • This study investigates the relationship between ventricular rate in AF and coronary blood flow dynamics.

Purpose of the Study:

  • To computationally explore the impact of ventricular rate during AF on coronary perfusion.
  • To quantify the extent to which heart rate variations in AF affect coronary blood flow.
  • To analyze the hemodynamic alterations in the coronary circulation under simulated AF conditions.

Main Methods:

  • A validated 0D-1D multiscale model simulating the heart and arterial tree, including coronary circulation.
  • AF was simulated at various ventricular rates (50-130 bpm) using stochastic RR interval extraction.
  • Hemodynamic parameters of the left anterior descending (LAD) artery, including flow waveform, amplitude, and perfusion, were analyzed.

Main Results:

  • Increased heart rate and beat-to-beat variability significantly alter LAD flow waveform and amplitude.
  • Coronary circulation amplifies beat-to-beat variability as heart rate increases, even with constant input variability.
  • Hemodynamic alterations are directly associated with both heart rate elevation and variability.

Conclusions:

  • Higher ventricular rates in AF lead to impaired coronary blood flow and myocardial oxygen supply-demand imbalance.
  • Coronary perfusion impairment worsens significantly above 90-110 bpm in AF due to combined heart rate and hemodynamic variability.
  • Coronary perfusion pressure is an unreliable indicator of myocardial perfusion at heart rates exceeding 90 bpm in AF.
Abstract

Keywords:
Atrial fibrillationCardiovascular multiscale modellingComputational hemodynamicsCoronary blood flowHeart rate

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