AbstractThe left atrium (LA) has a complex anatomy with heterogeneous wall thickness and curvature. The anatomy plays an important role in determining local wall stress; however, the relative contribution of wall thickness and curvature in determining wall stress in the LA is unknown. We have developed electromechanical finite element (FE) models of the LA using patient-specific anatomical FE meshes with rule-based myofiber directions. The models of the LA were passively inflated to 10mmHg followed by simulation of the contraction phase of the atrial cardiac cycle. The FE models predicted maximum LA volumes of 156.5 mL, 99.3 mL and 83.4 mL and ejection fractions of 36.9%, 32.0% and 25.2%. The median wall thickness in the 3 cases was calculated as $$1.32\, \pm \,0.78$$1.32±0.78 mm, $$1.21\, \pm \,0.85$$1.21±0.85 mm, and $$0.74\,\pm \,0.34$$0.74±0.34 mm. The median curvature was determined as $$0.159\,\pm \,0.080$$0.159±0.080 $$\hbox {mm}^{-1}$$mm-1, $$0.165\,\pm \,0.079\,\hbox {mm}^{-1}$$0.165±0.079mm-1, and $$0.166\,\pm \,0.077\,\hbox {mm}^{-1}$$0.166±0.077mm-1. Following passive inflation, the correlation of wall stress with the inverse of wall thickness and curvature was 0.55–0.62 and 0.20–0.25, respectively. At peak contraction, the correlation of wall stress with the inverse of wall thickness and curvature was 0.38–0.44 and 0.16–0.34, respectively. In the LA, the 1st principal Cauchy stress is more dependent on wall thickness than curvature during passive inflation and both correlations decrease during active contraction. This emphasizes the importance of including the heterogeneous wall thickness in electromechanical FE simulations of the LA. Overall, simulation results and sensitivity analyses show that in complex atrial anatomy it is unlikely that a simple anatomical-based law can be used to estimate local wall stress, demonstrating the importance of FE analyses.