Article Impact Level: HIGH Data Quality: STRONG Summary of Case Reports https://doi.org/10.1016/j.jaccas.2025.105838 Dr. Maria Segarra-Queralt et al.
Points
- This multiscale computational model utilizes three dimensional reconstructions from patient scans to simulate heart hemodynamics and biochemical thrombus formation events for individuals undergoing left atrial appendage occlusion procedures.
- A proof of concept study involving a seventy eight year old patient demonstrated that the model could accurately predict fibrin buildup beneath the pulmonary ridge after device installation.
- The research indicates that incomplete coverage of the pulmonary ridge by the occlusion device significantly increases the risk of recurrent device related thrombosis when anticoagulant dosages are reduced.
- Clinicians can utilize these personalized simulations during the preoperative phase to identify the optimal anatomical position for the device to ensure maximum safety and procedural success for patients.
- The integration of pharmacological data into the heart model allows for the precise adjustment of anticoagulant therapy during the postoperative period to minimize the risk of internal bleeding.
Summary
his study presents a pioneering multiscale computational model designed to optimize left atrial appendage occlusion (LAAO) and manage postoperative anticoagulation in patients with atrial fibrillation (AF). While LAAO is a critical alternative for patients with high bleeding risks, device-related thrombosis (DRT) persists as a major clinical hurdle. The model utilizes patient-specific 3D reconstructions from computerized tomography (CT) scans to integrate hemodynamics with the biochemical pathways of thrombus formation and the pharmacodynamics of antithrombotic agents like apixaban.
A proof-of-concept analysis was conducted on a 78-year-old male with AF and a history of intracranial hemorrhage. The patient received a 22-mm Amplatzer Amulet device, but subsequently developed DRT after transitioning from apixaban to aspirin. Although the thrombi resolved upon resuming apixaban, they recurred following a second discontinuation. The computational model successfully replicated these clinical events, identifying specific fibrin accumulation beneath the pulmonary ridge that matched the location of the thrombus observed in vivo.
The simulation revealed that DRT recurrence resulted from the synergistic effect of incomplete pulmonary ridge coverage and the cessation of direct oral anticoagulants. Virtual optimization demonstrated that adjusting the device’s position to fully cover the pulmonary ridge prevented fibrin formation even in the absence of intensive anticoagulation. These findings suggest that this computational framework can significantly enhance preoperative planning and postoperative care, allowing for precise device positioning and data-driven reductions in anticoagulant dosages to improve overall patient safety.
Link to the article: https://www.jacc.org/doi/10.1016/j.jaccas.2025.105838
References
Segarra-Queralt, M., Molla, M., Barrouhou, M., Olivares, A. L., Albors, C., Bernardino, G., Regueiro, A., Mill, J., Càmara, Ò., & Freixa, X. (2025). The role of anticoagulants after left atrial appendage occlusion. JACC: Case Reports https://doi.org/10.1016/j.jaccas.2025.105838
