A novel immersive catheter ablation simulator based on individualized 3D MR patients' heart models improves ablation performance of future electrophysiologists

Abstract Background Arrhythmias are rising worldwide due to population aging. Efficient training of next generation of electrophysiologists (EPs) to perform catheter (cath) ablation (CA) of arrhythmias is needed. Dedicated simulators for EP training based on individualized patients’ anatomy do not exist yet. Purpose To assess the potential training benefit of a novel augmented reality-based simulator for ablations. Methods The ARTS platform, consisting of the ARTSim simulator and the HeARTS AI software, utilizes 3D heart models of patients to enable the planning and simulation of personalized ablation procedures (Figure 1A-C). ARTSim incorporates innovative artificial intelligence-based techniques for digitizing and tracking the movements of a physical ablation cath in real time, thereby enabling its precise navigation within a completely virtual 3D heart (Figure 1B) generated automatically from patients’ MRI scans. Experienced EPs (n=4) and non-EPs (n=5) were trained on ARTSim. Five baseline right atrial flutter ablations (RA-FlAbl) were performed in 5 different hearts to gather baseline values, followed by another 15 RA-FlAbl for training. Then, the baseline RA-FlAbl were performed again. First, the doctors had to intubate and reach a predefined target in the coronary sinus (CS, Figure 1C), followed by ablation of pre-defined targets placed along the cavo-tricuspid isthmus line (Figure 1C, yellow point). Success was defined by placing the cath tip within 3mm of the target (white), with force of >3g (pink) for >5sec (red). Safety was considered for cath force <30g, (Figure 1C). Procedure time, cath tip trajectory, and contact force >30g and >50g were acquired. Results 225 RA-FlAbl procedures were performed. The training effect was evaluated in 5 ablations performed at baseline and repeated at the end of training (n=90). Final database consisted of 86 ablations (4 drop-outs). At baseline, non-EPs had 2.6 times longer procedure duration (p<0.001) and 2.6 times longer cath trajectories (p<0.001), and 2.0 times higher contact force (>50g, p<0.04, Figure 2) than EPs. After training on HeARTS, differences vs EPs were no longer significant for duration, trajectory, and high contact forces (Figure 2). EPs improved slightly for duration and trajectory (Figure 2). Conclusions Non-EPs obtained a comparable efficacy and safety profile than that of experienced EPs for RA-FlAbl after training on the ARTSim simulator.ARTSim Set-up and ablation criteria Training results for EPs and non-EPs