Automatic identification of optimal transseptal puncture localization and device configuration with patient-specific haemodynamic modelling in patients undergoing left atrial appendage occlusion

Abstract

Atrial Fibrillation affects 33.5 million people worldwide. It is associated with life-threatening consequences such as stroke, placing a heavy burden on healthcare resources. Stroke prevention is based on administering direct oral anticoagulants (DOACs) and for those contraindicated left atrial appendage occlusion (LAAO) is recommended. Still, after LAAO, a short-term period of anticoagulation is needed to avoid device-related thrombus. Predicting the minimal dose of anticoagulant administered after the intervention might reduce DOAC’s side effects. Therefore, we present a multi-therapeutic model that combines LAAO flow simulations with DOAC monitoring. Six simulations representing different clinical practice scenarios are performed: LAAO covering and uncovering the pulmonary ridge with or without 2.5 mg apixaban. Results show that applying 2.5 mg of Apixaban reduces the risk of DRT no matter the position of the occluder in the pulmonary ridge. Future steps should address the integration of more anticoagulant therapies. Despite being a proof-of-concept, we successfully developed a multi-therapeutic approach that evaluates the formation of DRT in different clinical scenarios.