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Computational fluid dynamics (CFD) studies of left atrial flows have reacheda sophisticated level, e.g., revealing plausible relationships betweenhemodynamics and stresses with atrial fibrillation. However, little focus hasbeen on fundamental fluid modelling of LA flows. The purpose of this study wasto investigate the spatiotemporal convergence, along with the differencesbetween high- (HR) versus normal-resolution/accuracy (NR) solution strategies,respectively. CFD simulations on 12 patient-specific left atrial geometries,obtained from computed tomography scans, were performed by using a second-orderaccurate and space/time centered solver. The convergence studies showed anaverage variability of around 30\% and 55\% for time averaged wall shear stress(WSS), oscillatory shear index (OSI), relative residence time (RRT), andendothelial cell activation potential (ECAP), even between intermediate spatialand temporal resolutions, in the left atrium (LA) and left atrial appendage(LAA), respectively. The comparison between HR and NR simulations showed goodcorrelation in the LA for WSS, RRT, and ECAP (R^2 > 0.9), but not for OSI (R^2= 0.63). However, there were poor correlations in the LAA especially for OSI,RRT, and ECAP (R^2 = 0.55, 0.63, and 0.61, respectively), except for WSS (R^2 =0.81). The errors are comparable to differences previously reported withdisease correlations. To robustly predict atrial hemodynamics and stresses,numerical resolutions of 10M elements and 10k time-steps per cycle seemnecessary (i.e., one order of magnitude higher than normally used in both spaceand time). In conclusion, attention to fundamental numerical aspects isessential towards establishing a plausible, robust, and reliable model of LAflows.

On The Importance of Fundamental Computational Fluid Dynamics Towards a  Robust and Reliable Model of Left Atrial Flows: Is There More Than Meets the  Eye?