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Background: The arrhythmogenic role of atrial complex morphology has not yetbeen clearly elucidated. We hypothesized that bumpy tissue geometry can induceaction potential duration (APD) dispersion and wavebreak in atrial fibrillation(AF).  Methods and Results: We simulated 2D-bumpy atrial model by varying the degreeof bumpiness, and 3D-left atrial (LA) models integrated by LA computedtomographic (CT) images taken from 14 patients with persistent AF. We alsoanalyzed wave-dynamic parameters with bipolar electrograms during AF andcompared them with LA-CT geometry in 30 patients with persistent AF. In2D-bumpy model, APD dispersion increased (p<0.001) and wavebreak occurredspontaneously when the surface bumpiness was higher, showing phasetransition-like behavior (p<0.001). Bumpiness gradient 2D-model showed thatspiral wave drifted in the direction of higher bumpiness, and phase singularity(PS) points were mostly located in areas with higher bumpiness. In 3D-LA model,PS density was higher in LA appendage (LAA) compared to other LA parts(p<0.05). In 30 persistent AF patients, the surface bumpiness of LAA was5.8-times that of other LA parts (p<0.001), and exceeded critical bumpiness toinduce wavebreak. Wave dynamics complexity parameters were consistentlydominant in LAA (p<0.001).  Conclusion: The bumpy tissue geometry promotes APD dispersion, wavebreak, andspiral wave drift in in silico human atrial tissue, and corresponds to clinicalelectro-anatomical maps.

Pro-arrhythmogenic effects of heterogeneous tissue curvature: A suggestion for role of left atrial appendage in atrial fibrillation