Atrial Fibrillation and Anterior Cerebral Artery Absence Reduce Cerebral Perfusion: A De Novo Hemodynamic Model

Background: Atrial fibrillation is a prevalent cardiac arrhythmia and may reduce cerebral blood perfusion augmenting the risk of dementia. We hypothesize that geometric variations in the cerebral arterial structure called the Circle of Willis (CoW) play an important role in influencing cerebral perfusion. The objective of this work was to develop a novel cardio-cerebral lumped parameter hemodynamic model to investigate the role of CoW variants on cerebral blood flow dynamics under atrial fibrillation conditions. Methods: A computational blood flow model was developed by coupling whole-body and detailed cerebral circulation descriptions, modified to represent six common variations of the CoW. Cerebral blood flow dynamics were simulated in common CoW variants, under control and imposed atrial fibrillation conditions. Risk was assessed based on the frequency of beat-wise hypoperfusion events, and sensitivity analysis was performed with respect to this model output. Results: It was found that the geometry of the CoW influenced the frequency of hypoperfusion events at different heart rates, with the variant missing a P1 segment having the highest risk. Sensitivity analysis revealed that intrinsic heart rate is most associated with the considered outcome. Conclusions: Our results suggest that CoW geometry plays an important role in influencing cerebral hemodynamics during atrial fibrillation. The presented study may assist in guiding our future clinical-imaging research.