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Rule-based methods are often used for assigning fiber orientation to cardiacanatomical models. However, existing methods have been developed using datamostly from the left ventricle. As a consequence, fiber information obtainedfrom rule-based methods often does not match histological data in other areasof the heart such as the right ventricle, having a negative impact in cardiacsimulations beyond the left ventricle. In this work, we present a rule-basedmethod where fiber orientation is separately modeled in each ventriclefollowing observations from histology. This allows to create detailed fiberorientation in specific regions such as the endocardium of the right ventricle,the interventricular septum and the outflow tracts. We also carried outelectrophysiological simulations involving these structures and with differentfiber configurations. In particular, we built a modelling pipeline for creatingpatient-specific volumetric meshes of biventricular geometries, including theoutflow tracts, and subsequently simulate the electrical wavefront propagationin outflow tract ventricular arrhythmias with different origins for the ectopicfocus. The resulting simulations with the proposed rule-based method showed avery good agreement with clinical parameters such as the 10 ms isochrone ratioin a cohort of nine patients suffering from this type of arrhythmia. Thedeveloped modelling pipeline confirms its potential for an in silicoidentification of the site of origin in outflow tract ventricular arrhythmiasbefore clinical intervention.

A rule-based method to model myocardial fiber orientation in cardiac biventricular geometries with outflow tracts