Department of Pharmacology, University of California Davis, Davis, CA, USA.
Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.
Int J Cardiol. 2019 Jul 15;287:155-161. doi: 10.1016/j.ijcard.2019.01.077. Epub 2019 Jan 25.
Atrial fibrillation (AF) is a complex cardiac arrhythmia with diverse etiology that negatively affects morbidity and mortality of millions of patients. Technological and experimental advances have provided a wealth of information on the pathogenesis of AF, highlighting a multitude of mechanisms involved in arrhythmia initiation and maintenance, and disease progression. However, it remains challenging to identify the predominant mechanisms for specific subgroups of AF patients, which, together with an incomplete understanding of the pleiotropic effects of antiarrhythmic therapies, likely contributes to the suboptimal efficacy of current antiarrhythmic approaches. Computer modeling of cardiac electrophysiology has advanced in parallel to experimental research and provides an integrative framework to attempt to overcome some of these challenges. Multi-scale cardiac modeling and simulation integrate structural and functional data from experimental and clinical work with knowledge of atrial electrophysiological mechanisms and dynamics, thereby improving our understanding of AF mechanisms and therapy. In this review, we describe recent advances in our quantitative understanding of AF through mathematical models. We discuss computational modeling of AF mechanisms and therapy using detailed, mechanistic cell/tissue-level models, including approaches to incorporate variability in patient populations. We also highlight efforts using whole-atria models to improve catheter ablation therapies. Finally, we describe recent efforts and suggest future extensions to model clinical concepts of AF using patient-level models.
心房颤动（AF）是一种复杂的心律失常，病因多样，对数百万人的发病率和死亡率产生负面影响。技术和实验的进步为 AF 的发病机制提供了丰富的信息，突出了与心律失常的起始和维持以及疾病进展相关的多种机制。然而，要确定特定亚组的 AF 患者的主要机制仍然具有挑战性，这与抗心律失常治疗的多效性作用的不完全理解一起，可能导致当前抗心律失常方法的疗效不佳。心脏电生理学的计算机建模与实验研究并行发展，为克服这些挑战提供了一个综合框架。多尺度心脏建模和模拟将来自实验和临床工作的结构和功能数据与心房电生理机制和动力学的知识相结合，从而提高我们对 AF 机制和治疗的理解。在这篇综述中，我们通过数学模型描述了我们对 AF 的定量理解的最新进展。我们讨论了使用详细的、基于机制的细胞/组织水平模型来进行 AF 机制和治疗的计算建模，包括针对患者群体变异性的方法。我们还强调了使用整个心房模型来改善导管消融治疗的努力。最后，我们描述了使用基于患者水平的模型来模拟 AF 临床概念的最新努力并提出了未来的扩展方向。
