Kozlowski, P.; Muthukumarasamy, K. M.; Deshmukh, A.; Monteiro da Rocha, A.; Oral, H.

Background: Human in vitro models for atrial fibrillation (AF) are limited. Human-induced pluripotent stem cell-derived atrial cardiomyocytes (hiPSC-aCMs) provide a valuable tool to study AF pathophysiology by facilitating in vitro modeling. Objectives: To investigate the effects of an intermittent tachypacing protocol (ITPP) in matured hiPSC-aCMs co-cultured with human atrial cardiac fibroblast (haCF) to mimic AF-associated electroanatomical phenotypes. Methods and Results: hiPSC-aCMs were cultured alone or co-cultured with haCFs at 90/10 and 70/30 ratios. ITPP was applied through field stimulation, and optical mapping assessed action potentials (APs) and calcium transients (CaTs). Immunostaining was performed to quantify pro-fibrotic biomarkers (Collagen III and TGF{beta}1). ITPP led to increased spontaneous AP frequency ({Delta}=+31{+/-}7%, P<0.0001) and reduced AP duration at 80% repolarization (APD80%; {Delta}=-15{+/-}4%, P=0.001). Additionally, the upstroke slope ({Delta}=-41{+/-}11%, P=0.001) and amplitude (dF/F0; {Delta}=-51{+/-}13%, P<0.001) of intracellular CaT were significantly reduced. Co-culture at the 70/30 hiPSC-aCM/haCF ratio, showed a >100-fold increase in Collagen III expression (P<0.0001), diminished excitability ({Delta}Hz=-61{+/-}6%, P<0.0001), prolonged {Delta}APD80% ({Delta}=+130{+/-}10%, P<0.0001), prolonged AP triangulation ({Delta}APDTri=+143{+/-}13%, P<0.0001), reduced upstroke slope ({Delta}=-66{+/-}6%, P<0.0001), conduction block ({Delta}=-52{+/-}18%, P=0.0260), and diminished intracellular calcium handling (upstroke slope {Delta}=-50{+/-}8%, P<0.0001;dF/F0=-34{+/-}9%, P=0.0003). Finally, the application of ITPP to the 70/30 co-culture model recapitulated an AF-mediated phenotype ({Delta}Hz=+25{+/-}8%, P=0.02; {Delta}APD80%=-16{+/-}6%, P=0.01) while introducing conduction block ({Delta}CV100/0 vs 70/30= -27{+/-}15 %; P=0.0005). Conclusions: Co-cultures of matured hiPSC-aCMs and haCFs exhibited structural and electrophysiological remodeling, including conduction abnormalities, mirroring key AF mechanisms. This model holds potential for patient-specific therapies and drug discovery.