Three-Dimensional Representation of Atrial Anatomy and Electrophysiology Enhanced by Mixed Reality

Teaching cardiac anatomy and electrophysiology involves conveying complex three-dimensional (3D) structures, which is pivotal for understanding the ECG genesis.The P wave morphology is affected by multiple factors, including the sinoatrial node location and extent, and points of myocardial capture.For three exemplary ECGs extracted from the PTB-XL database -normal, inverted / negative and an interatrial block (IAB) P waves, we performed CineECG analysis on a highly detailed generic anatomical atrial model.We qualitatively evaluated SAN exit points locations and corresponding activation trajectories and sequences.The results were exported into the mixed reality Hololenses 2 system for enhanced visualization.As expected, normal and negative P waves were found to feature superior and inferior SAN capture points with top-down and down-top average activation trajectories, respectively.The considered IAB provided a markedly distinct excitation pattern with the right-left pattern.These differences were further highlighted by visualising the complex electro-anatomical interplay of cardiac excitation in the immersive mixed reality environment.This work presents novel mixed reality 3D visualization options for atrial anatomy in high spatial resolution augmented by the respective P wave genesis.