Computerized Modeling of Electrophysiology and Pathoelectrophysiology of the Atria -- How Much Detail is Needed?

This review focuses on the computerized modeling of the electrophysiology of the human atria, emphasizing the simulation of common arrhythmias such as atrial flutter (AFlut) and atrial fibrillation (AFib). Which components of the model are necessary to accurately model arrhythmogenic tissue modifications, including remodeling, cardiomyopathy, and fibrosis, to ensure reliable simulations? The central question explored is the level of detail required for trustworthy simulations for a specific context of use. The review discusses the balance between model complexity and computational efficiency, highlighting the risks of oversimplification and excessive detail. It covers various aspects of atrial modeling, from cellular to whole atria levels, including the influence of atrial geometry, fiber direction, anisotropy, and wall thickness on simulation outcomes. The article also examines the impact of different modeling approaches, such as volumetric 3D models, bilayer models, and single surface models, on the realism of simulations. In addition, it reviews the latest advances in the modeling of fibrotic tissue and the verification and validation of atrial models. The intended use of these models in planning and optimization of atrial ablation strategies is discussed, with a focus on personalized modeling for individual patients and cohort-based approaches for broader applications. The review concludes by emphasizing the importance of integrating experimental data and clinical validation to enhance the utility of computerized atrial models to improve patient outcomes.