Genesis of Atrial Fibrillation Under Different Diffuse Fibrosis Density Related with Atmospheric Pollution. In-Silico Study

Atrial remodeling is a widely acknowledged process that accelerates the susceptibility to and progression of atrial fibrillation. An increasingly recognized structural component is atrial fibrosis. Recent studies have shown that air pollution increases the risk of heart arrhythmias, where the exposure to particulate matter (PM) contributes to the generation of myocardial fibrosis, increasing the cardiovascular risk. The density and patterns of fibrosis (interstitial, compact and diffuse) are relevant in abnormal conduction and vulnerability to cardiac arrhythmias. Taking into account that fibrosis has been widely reported as one of the consequences of PM exposure, in this work, we evaluated the effects of low and high diffuse fibrosis density on conduction velocity and arrhythmic propagation patterns. For this purpose, cellular models of atrial myocyte and fibroblast were implemented in a 3D model of the human atria. Low (6.25%) and high (25%) fibrosis densities were simulated in the left atrium and its effect on conduction velocity and fibrillatory dynamics was evaluated. Results showed a conduction velocity reduction of 71% associated with a high fibrosis density. At low fibrosis density, few reentries were observed. On the other hand, at high fibrosis density, irregular propagation patterns, characterized by multiple wavelets and rotors, were observed. Our results suggest that high diffuse fibrosis density is associated with a significant conduction velocity reduction and with chaotic propagation patterns during atrial fibrillation.