Initiation of atrial fibrillation by interaction of pacemakers with geometrical constraints

• A simplified cell model was adapted to atrial electrophysiology.
• Geometrical constraints lead to conduction blocks and detachment of waves.
• Additional interaction of waves yields irregular activation patterns.
• In combination with reduced excitability fibrillatory-like patterns occur.
• Formation of fibrillatory-like patterns depends on frequencies and isthmus width.

Atrial fibrillation (AF) is the most common arrhythmia of the heart in industrialized countries. Its generation and the transitory behavior of paroxysmal AF are still not well understood. In this work we examine the interaction of two activation sources via an isthmus as possible cause for the initiation of fibrillation episodes. For this study, the electrophysiological model of Bueno-Orovio, Cherry and Fenton is adapted to atrial electrophysiology, both for physiological and electrophysiologically remodeled conditions due to AF. We show that the interaction of the pacemakers, combined with the geometrical constraints of the isthmus, can produce fibrillatory-type irregularities, which we quantify by the loss of spatial phase coherence in the transmembrane voltage. Transitions to irregular behavior occur when the frequencies of the pacemakers exceed certain thresholds, suggesting that AF episodes are initiated by frequency changes of the activating sources (sinus node, ectopic focus).

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