An in vitro assessment of atrial fibrillation flow types on cardiogenic emboli trajectory paths

Abstract

Atrial fibrillation is the most significant contributor to thrombus formation within the heart and is responsible for 45% of all cardio embolic strokes, which account for approximately 15% of acute ischemic strokes cases worldwide. Atrial fibrillation can result in a reduction of normal cardiac output and cycle length of up to 30% and 40%, respectively. A total of 240 embolus analogues were released into a thin-walled, patient-specific aortic arch under normal (60 embolus analogues) and varying atrial fibrillation (180 embolus analogues) pulsatile flow conditions. Under healthy flow conditions (n = 60), the embolus analogues tended to follow the flow rate split through each outlet vessel. There was an increase in clot trajectories along the common carotid arteries under atrial fibrillation flow conditions. A shorter pulse period (0.3 s) displayed the highest percentage of clots travelling to the brain (24%), with a greater percentage of clots travelling through the left common carotid artery (17%). This study provides an experimental insight into the effect varying cardiac output and cycle length can have on the trajectory of a cardiac source blood clots travelling to the cerebral vasculature and possibly causing a stroke.

Distribution of Artificial Thrombi Candidates Through Patient-Specific Aortic-Arch Phantoms under Pulsatile Flow Conditions

“…Carr [9] provides simulations and cardiogenic emboli distributions in the aortic arch and shows that, on average, particles in the size from 910 microns to 1920 microns have twice the likelihood of cardiac output to the arteries leading to the brain. Lately, Malone presented results indicating that blood clots made from bovine blood followed the owrate percentages of atrial brillation pulsatile signals for aortic-arch phantoms made of silicone with arti cial blood liquid as a medium [10].…”

Effect of mean heart rate on 30-day mortality in ischemic stroke with atrial fibrillation: Data from the MIMIC-IV database

“…However, most of the previous studies on the relationship between heart rate and prognosis of ischemic stroke have been conducted in patients with mild to moderate stroke, and the definition of heart rate parameters varies from study to study, and most of them focus on the relationship between heart rate parameters and medium-and long-term prognosis. As it has an erratic rhythm, atrial fibrillation (AF), which is the most frequent reason for heart thrombus development and is to blame for 45% of cardiogenic strokes (20), has often been excluded. The association between mean heart rate (MHR) and stroke prognosis in patients with atrial fibrillation is uncertain because most studies did not include patients with AF.…”