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

Background Arrhythmias are rising worldwide owing to population aging. Efficient ablation training of next-generation electrophysiologists (EPs) is crucial. Dedicated simulators for EP training based on individual patient anatomy do not exist yet. Objective This study aimed to assess the potential training effects of a novel advanced augmented reality (AAR)–based simulator for ablations. Methods An AAR-based simulator (ADIS SA, Lausanne, Switzerland) tracks the movements of a physical ablation catheter (Imricor, Burnsville, MN) in real time within a completely virtual 3-dimensional heart generated from cardiac magnetic resonance examinations. Experienced EPs (n = 4) and non-EP cardiologists (n = 5) were trained in catheter steering skills. They performed 5 baseline right atrial flutter ablations (RA-FlAbls) in 5 different hearts, another 15 RA-FlAbl for training, and again 5 RA-FlAbl in the 5 baseline hearts. Efficacy (procedure time/catheter trajectory) and safety (high-force wall contacts >50 g) were recorded for coronary sinus cannulation and cavotricuspid isthmus ablations. Results 224 RA-FlAbl were performed. The training effect was evaluated using the 5 baseline and 5 post-training RA-FlAbl (43 pairs, 4 dropouts). Before training, non-EPs had 2.6 times longer procedural time and catheter trajectories than EPs (each P < .001; after training each nonsignificant) and 2.0 times more high-force wall contacts ( P < .04; after training nonsignificant). EPs also demonstrated modest improvements in ablation efficacy ( P < .003), but not for the simpler task of coronary sinus cannulation. Conclusion This feasibility study shows that training by means of an augmented reality-based simulator improves both the efficacy and safety of catheter steering skills for RA-FlAbl of EP trainees. After the training, they obtained a comparable efficacy and safety profile as experienced EPs.