Patient-Specific Multi-Physics Simulations: Impact of Fibrotic Changes on Left Atrial Hemodynamics

Interview With Nazem Akoum, MD, MS, FACC, FAHA, FHRS

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Interview by Jodie Elrod

Watch as Nazem Akoum, MD, MS, FACC, FAHA, FHRS, from UW Medicine, discusses his presentation at Western AF 2025.

Tell us about your presentation at the Western AFib Symposium 2025. 

My name is Nazem Akoum. I am a cardiac electrophysiologist, and I lead the electrophysiology program at the University of Washington, where I take care of patients and also do research related to atrial fibrillation (AFib) and stroke related to AFib. 

Today, I am excited to share some results on the research we're doing on a particular aspect of AFib care, which is trying to understand from a mechanistic perspective why some of our AFib patients have thrombi form in their heart and subsequently are at risk for having a stroke. So, we know that stroke is one of the most devastating and complicating scenarios when someone is diagnosed with AFib, and the treatments that are currently offered and not very personal. We use anticoagulants, for example, and we put a large number of patients on those. Sometimes it's overkill, where we're anticoagulating that people shouldn't be, and sometimes they're not as effective. There are alternatives to anticoagulants, but what my group and my lab is focused on is trying to understand why and how a clot forms in a person's heart. I'm going to share our work on that today. 

What are the take-home messages you would like viewers to leave with?

What we are modeling is how does a clot form, and we are using data that's acquired from the patients. So, our patients undergo advanced cardiac imaging with MRI, and that helps us take their own personal anatomy into consideration. But it's not just the anatomy where you may be aware of, for example, changes in the shape of the atrial appendage that can influence somebody's stroke risk. But we're also interested in the changes that are happening within the walls of the atrium, specifically fibrotic changes, and how those affect the function of the atrium, both in the way it relaxes and also in the way that it contracts, because both of these factors come together and create a situation where the blood has more chance to be stagnant, and therefore, form a clot. We're exploring the role of fibrosis in the atrial walls in that process.