Role of fiber orientation in atrial arrythmogenesis

Electrical wave-front propagation in the atria is determined largely by local fiber orientation. Recent study suggests that atrial fibrillation (AF) progresses with enhanced anisotropy. In this work, a 3D rabbit atrial anatomical model at 20×20×20 μm³ resolution with realistic fiber orientation was constructed based on the novel contrast-enhanced micro-CT imaging. The Fenton-Karma cellular activation model was adapted to reproduce rabbit atrial action potential period of 80 ms. Diffusivities were estimated for longitudinal and transverse directions of the fiber orientation respectively. Pacing was conducted in the 3D anisotropic atrial model with a reducing S₂ interval to facilitate initiation of atrial arrhythmia. Multiple simulations were conducted with varying values of diffusion anisotropy and stimulus locations to evaluate the role of anisotropy in initiating AF. Under physiological anisotropy conditions, a rapid right atrial activation was followed by the left atrial activation. Excitation waves reached the atrio-ventricular border where they terminated. Upon reduction of conduction heterogeneity, re-entry was initiated by the rapid pacing and the activation of both atrial chambers was almost simultaneous. Myofiber orientation is an effective mechanism for regulating atrial activation. Modification of myoarchitecture is proarrhythmic.