Skip to main content

In-Silico Analysis of the Influence of Pulmonary Vein Configuration on Left Atrial Haemodynamics and Thrombus Formation in a Large Cohort

Part of the Lecture Notes in Computer Science book series (LNIP,volume 12738)


Atrial fibrillation (AF) is considered the most common human arrhythmia. Around 99% of thrombi in non-valvular AF are formed in the left atrial appendage (LAA). Studies suggest that abnormal LAA haemodynamics and the subsequently stagnated flow are the factors triggering clot formation. However, the relation between LAA morphology, the blood pattern and the triggering is not fully understood. Moreover, the impact of structures such as the pulmonary veins (PVs) on LA haemodynamics has not been thoroughly studied due to the difficulties of acquiring appropriate data. On the other hand, in-silico studies and flow simulations allow a thorough analysis of haemodynamics, analysing the 4D nature of blood flow patterns under different boundary conditions. However, the reduced number of cases reported on the literature of these studies has been a limitation. The main goal of this work was to study the influence of PVs on left atrium (LA) and LAA haemodynamics. Computational fluid dynamics simulations were run on 52 patients, the largest cohort so far in the literature, where different parameters were individually studied: pulmonary veins orientation and configuration; LAA and LA volumes and its ratio; and flow velocities. Our computational analysis showed how the right pulmonary vein height and angulation have a great influence on LA haemodynamics. Additionally, we found that LAA with great bending with its tip pointing towards the mitral valve could contribute to favour flow stagnation.


  • Pulmonary veins
  • Computational fluid dynamics
  • Left atrium haemodynamics and thrombus formation

This is a preview of subscription content, access via your institution.

Buying options

USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions


  1. 1.


  1. Rahman, F., Kwan, G.F., Benjamin, E.J.: Global epidemiology of atrial fibrillation. Nat. Rev. Cardiol. 11(11), 639–654 (2014)

    Google Scholar 

  2. Cresti, A., et al.: Prevalence of extra-appendage thrombosis in non-valvular atrial fibrillation and atrial flutter in patients undergoing cardioversion: a large transoesophageal echo study. EuroIntervention : Journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 15(3), e225–e230 (2019)

    Google Scholar 

  3. Di Biase, L., et al.: Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J. Am. Coll. Cardiol. 60(6), 531–538 (2012)

    Google Scholar 

  4. Watson, T., Shantsila, E., Lip, G.Y.H.: Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. Lancet 373(9658), 155–166 (2009)

    Google Scholar 

  5. Naser, A., et al.: Left atrial blood stasis and Von Willebrand factor-ADAMTS13 homeostasis in atrial fibrillation. Arterioscler. Thromb. Vasc. Biol. 31(11), 2760–2766 (2011)

    Google Scholar 

  6. Cronin, P., et al.: Normative analysis of pulmonary vein drainage patterns on multidetector CT With Measurements of pulmonary vein ostial diameter and distance to first bifurcation. Acad. Radiol. 14(2), 178–188 (2007)

    Google Scholar 

  7. Marom, E.M., Herndon, J.E., Kim, Y.H., McAdams, H.P.: Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology 230(3), 824–829 (2004)

    Google Scholar 

  8. Beigel, R., Wunderlich, N.C., Ho, S.Y., Arsanjani, R., Siegel, R.J.: The left atrial appendage: Anatomy, function, and noninvasive evaluation. JACC: Cardiovasc. Imaging 7(12), 1251–1265 (2014)

    Google Scholar 

  9. Markl, M., et al.: Assessment of left atrial and left atrial appendage flow and stasis in atrial fibrillation. J. Cardiovasc. Magn. Reson. 17(1), M3 (2015)

    Google Scholar 

  10. Guadalupe, G.I., et al.: Sensitivity analysis of geometrical parameters to study haemodynamics and thrombus formation in the left atrial appendage. Int. J. Numer. Meth. Biomed. Eng. Acepted(ja), 122–140 (2018)

    Google Scholar 

  11. Fumagalli, I., et al.: An image-based computational hemodynamics study of the Systolic Anterior Motion of the mitral valve. Comput. Biol. Med. 123, 103922 (2020)

    Google Scholar 

  12. Otani, T., et al.: A computational framework for personalized blood flow analysis in the human left atrium. Ann. Biomed. Eng. 44(11), 3284–3294 (2016).

    CrossRef  Google Scholar 

  13. Veronesi, F., et al.: Quantification of mitral apparatus dynamics in functional and ischemic mitral regurgitation using real-time 3-dimensional echocardiography. J. Am. Soc. Echocardiograph. 21(4), 347–354 (2008)

    Google Scholar 

  14. Bône, Alexandre, Louis, Maxime, Martin, Benoît, Durrleman, Stanley: Deformetrica 4: an open-source software for statistical shape analysis. In: Reuter, Martin, Wachinger, Christian, Lombaert, Hervé, Paniagua, Beatriz, Lüthi, Marcel, Egger, Bernhard (eds.) ShapeMI 2018. LNCS, vol. 11167, pp. 3–13. Springer, Cham (2018).

    CrossRef  Google Scholar 

  15. Yaghi, S., et al.: The left atrial appendage morphology is associated with embolic stroke subtypes using a simple classification system: a proof of concept study. J. Cardiovasc. Comput. Tomograph. 14(1), 27–33 (2020)

    Google Scholar 

Download references


This work was supported by the Agency for Management of University and Research Grants of the Generalitat de Catalunya under the Grants for the Contracting of New Research Staff Programme - FI (2020 FI_B 00608) and the Spanish Ministry of Economy and Competitiveness under the Programme for the Formation of Doctors (PRE2018-084062), the Maria de Maeztu Units of Excellence Programme (MDM-2015-0502) and the Retos Investigación project (RTI2018-101193-B-I00). Additionally, this work was supported by the H2020 EU SimCardioTest project (Digital transformation in Health and Care SC1-DTH-06-2020; grant agreement No. 101016496) and the European project PARIS (ID35).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jordi Mill .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Mill, J. et al. (2021). In-Silico Analysis of the Influence of Pulmonary Vein Configuration on Left Atrial Haemodynamics and Thrombus Formation in a Large Cohort. In: Ennis, D.B., Perotti, L.E., Wang, V.Y. (eds) Functional Imaging and Modeling of the Heart. FIMH 2021. Lecture Notes in Computer Science(), vol 12738. Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-78709-7

  • Online ISBN: 978-3-030-78710-3

  • eBook Packages: Computer ScienceComputer Science (R0)