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Modelling of thrombus formation, growth and embolisation in the left atrial appendage under atrial fibrillation

Lo Presti, Anna Maria; Monteleone, Alessandra; Musotto, Giulio; Tamburini, Alessandro; Napoli, Enrico; Burriesci, Gaetano; (2025) Modelling of thrombus formation, growth and embolisation in the left atrial appendage under atrial fibrillation. Computers in Biology and Medicine , 191 , Article 110134. 10.1016/j.compbiomed.2025.110134. Green open access

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Abstract

Left atrial appendage (LAA) thrombosis is a frequent and serious complication associated with atrial fibrillation (AF), which significantly increases the risk of ischemic events. The presence of a thrombus within the LAA can disrupt normal blood flow and eventually embolise, leading to impaired circulation and severe complications. An innovative fluid-structure interaction model, based on the smoothed particle hydrodynamics method, is used to simulate the formation and behaviour of thrombi in a patient-specific LAA morphology under AF condition. The clotting process is modelled by tracking the concentrations of key components involved in the coagulation cascade. The approach transforms fluid particles into a solid phase by applying internal spring forces when specific biochemical and haemodynamic conditions occur. The findings shed light on the haemodynamic and biochemical mechanisms driving thrombus formation and migration within the LAA, highlighting regions of clot growth and subsequent embolisation. Thrombus formation begins at the LAA tip, gradually expanding through lobes and trabeculae, and ultimately progressing internally to high-recirculation regions, increasing the risk of embolisation and of potential clinical complications. By accurately predicting thrombus formation, growth and fragmentation, this study offers valuable insight into the mechanisms associated with the thromboembolic risk in AF. These are crucial for developing targeted therapeutic strategies to minimise the risk of thromboembolic events in patient with AF.

Type: Article
Title: Modelling of thrombus formation, growth and embolisation in the left atrial appendage under atrial fibrillation
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.compbiomed.2025.110134
Publisher version: https://doi.org/10.1016/j.compbiomed.2025.110134
Language: English
Additional information: © 2025 The Authors. Published by Elsevier Ltd. under a Creative Commons license (http://creativecommons.org/licenses/by/4.0/).
Keywords: Left atrial appendage (LAA); Atrial fibrillation (AF); Thromboembolic risk; Thrombus formation; Smoothed particle hydrodynamics (SPH); Fluid-structure interaction (FSI)
UCL classification: UCL
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Mechanical Engineering
URI: https://discovery.ucl.ac.uk/id/eprint/10207134
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