Training in a novel advanced augmented reality-based ablation simulator: Using 3-dimensional magnetic resonance heart models of individual patients improves performance of future electrophysiologists

Figures

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  Figure 1. Overview of the screen during procedure. A: The simulator system is shown with the computer (on the right) to create the scenarios and the 3-dimensional simulator (on the left) for training. The interface allows you to load different scenarios, record the intervention, and store and export key parameters of performance. The simulator (screen on the left) shows the catheter motion in real time and key parameters such as force (g) against the wall. B–D: The heart is visualized in different 2-dimensional projections simultaneously. An example of a 3-dimensional model of a right atrium and a right ventricle is shown for cannulation of the CS and ablation of the CTI. The CS is marked by the large yellow sphere that must be reached for successful CS cannulation. The small white spheres are the targets placed on the CTI. Right anterior oblique view (B), left anterior oblique view (C), and left anterior oblique view with an inferior tilt (nonstandard) highlighting the CS (D). CS = coronary sinus; CTI = cavotricuspid isthmus; IVC = inferior vena cava; RA = right atrium; RV = right ventricle.

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  Figure 2. Flowchart of the study. Flowchart of all CS cannulations and CTI interventions. CS = coronary sinus; CTI = cavotricuspid isthmus.

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  Figure 3. Results for CS cannulation. CS cannulation performance before and after training for EPs vs non-EPs. Top: Results for efficacy (time and trajectory length) for CS cannulation. Bottom: The safety results (number of wall contacts with force of >30 g and >50 g). At baseline, non-EPs performed significantly worse than EPs for both efficacy and safety parameters. Non-EPs improved on all parameters after training, whereas EPs have not shown significant improvement. After training, non-EPs metrics were comparable in efficacy and safety with EPs. CS = coronary sinus; EP = electrophysiologist.

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  Figure 4. Results for catheter steering skills for CTI line ablation. Catheter steering skill performance to reach and ablate the targets on the CTI line before and after training in EPs vs non-EPs. Top: Results for efficacy (time and trajectory length) for ablation. Bottom: The safety results (number of wall contacts with force of >30 g and >50 g). At baseline, non-EPs performed significantly worse than EPs for both efficacy and the >50 g force safety parameters. Non-EPs improved on all parameters after training, whereas EPs only improved slightly in efficacy but not for force-50. After training, non-EPs were comparable in efficacy and safety with EPs. CTI = cavotricuspid isthmus; EP = electrophysiologist.

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  Figure 5. Ablation distance baseline vs post-training. An example of a catheter tip trajectory for a point on the CTI line is shown for a non-EP before (A) and after training (B). CTI = cavotricuspid isthmus; EP = electrophysiologist.

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  Supplementary Figure 1.