The Cardiac Rhythm Disease Management (CRDM) modules for the CathLabVR™ System — including Bradycardia, Heart Failure, Tachyarrhythmia, and Cardiac Resynchronization Therapy — allow the user to practice selective placement and fixation of cardiac pacing leads within a virtual 3D model of a beating heart. Computer-generated, real-time fluoroscopic images of the virtual patient permit users to visualize the selected catheters, guidewires, stylets, and pacing leads.

Immersive Virtual Reality Simulation

The surgical simulator’s fluoroscopic image may be rotated or magnified, and cine video loops or still images may be recorded as in a real catheterization lab. Additionally, an image of the virtual patient’s heart chambers and venous anatomy may be selected as a virtual aide to assist with identifying significant anatomy to help with the navigation of the pacing leads and other devices.

High-fidelity Medical Simulator

In addition to high-fidelity visual images, the CathLabVR surgical simulator provides the user with realistic tactile feedback, which is integrated with visual cues. The user will actually feel the forces encountered by pacing leads and devices as they are manipulated through the virtual patient’s anatomy to the desired location.

Endovascular Catheters, Balloons, Leads, Guidewires

The CathLabVR surgical simulator allows unique pacing tools, such as deflectable and steerable catheters, which are especially helpful for cases with torturous anatomy or hard to get to locations. Examples of these locations include near Bachmann’s Bundle and the right ventricular outflow tract. Users can shape or customize guidewires and stylets to help navigate the pacing lead. Both pre-shaped passive-fixation and active-fixation leads, as well as over-the-wire and stylet-driven leads are available for these cardiac rhythm cases

Training for Surgical Complications

The CathLabVR surgical simulator supports training in proper tool selection and tool-handling techniques within the virtual anatomy. As in a real procedure, improper technique or tools can cause complications, such as endocardial or venous dissection and cardiac or venous perforation by catheter, guidewire, or pacing lead. For the simulated cases to be completed, the surgical simulator’s endovascular training procedures require that complications be recognized and reated. Real-time ECG, blood pressure, and heart rate, as well as cardiac pacing and stimulation thresholds, are indicated to monitor the virtual patient’s status throughout the case.

Virtual Reality Heart Monitoring

The virtual patient’s heart is electrophysiologically appropriate. Pacing from the various locations produces responsive changes in the ECG signal. Real-time surface ECG leads may be evaluated. Pacing from certain anatomical locations can stimulate the phrenic nerve, causing diaphragmatic stimulation. Movement of the heart and the diaphragm can be observed on the real-time virtual reality fluoroscopy display.

Realistic Analysis

The CRDM module allows the user to evaluate the electrical performance of the pacing lead once it has been placed. Stimulation and sensing thresholds, and the effect of 10-volt pacing, can be tested using Analyzer functions within the simulator.

Training in Surgical Technique

The CRDM module includes training on placing the lead(s) in stable positions using passive- or active-fixation methods and carefully withdrawing the stylets, guidewires, or other tools used to assist lead placement in order to minimize lead displacement.

Objective, Automated Evaluation

After a virtual reality surgery is completed, the user may access the endovascular simulator’s Metrics page, which reports case parameters, (total fluoro time, contrast used, complications encountered and treated, electrical characteristics of the final lead position, etc.). These metrics allow the user and system administrators to evaluate performance for training or certification purposes.

The CRDM module includes cases for both bradycardia and heart failure pacing.