The CRDM Bradycardia module includes four simulated endovascular cases that allow the user to practice using fixed-shape or deflectable/steerable catheters to navigate active or passive fixation leads to the desired location: either atrial or ventricular. The simulated cases include various heart chamber sizes such as dilated ventricles, coronary sinus locations, and tight or truncated atrial appendages. Intentional or accidental cannulation of the virtual patient’s coronary sinus for placement of a left ventricular epicardial placement is also possible.

Virtual Patient

Due to the different anatomical variations of the virtual patients, users may need to select a different guide catheter, guidewire, and/or lead to improve the success of navigating to the desired location, such as through the tricuspid valve to the right ventricular outflow tract. For successful completion of the case, one should test the lead prior to and after fixation to confirm optimization of sensing and stimulation thresholds. All delivery instruments, including stylets and wires, should be carefully withdrawn to minimize dislodgement of the lead.

Realistic Surgical Simulation

The 3D heart model incorporates anatomy such as the tricuspid valve. The user will visualize and feel the valve as they navigate devices through it, if their intention is to fixate the lead in the right ventricle or the ventricle’s outflow tract. Additionally, realistic scenarios such as dislodgement of the lead, either due to the heart beating or withdrawal of support devices, such as stylets or guide catheters, adds to a realistic level of complexity associated with appropriately going through steps in order for suitable placement outcomes.

Objective Medical Training Evaluation

Afterwards, the user can examine the endovascular simulator’s “Metrics” or evaluation page to view objective criteria tracked during the case, including total fluoroscopy time, final placement, whether final electrical parameters were acceptable, and whether fixation of the lead was successfully accomplished.

The CRDM module also includes cases for heart failure pacing.