Use of a mixed reality system for navigational mapping during cardiac electrophysiological testing does not prolong case duration: A subanalysis from the Cardiac Augmented REality study

David Bloom; David Catherall; Nathan Miller; Michael K Southworth; Andrew C Glatz; Jonathan R Silva; Jennifer N Avari Silva

doi:10.1016/j.cvdhj.2023.06.003

Use of a mixed reality system for navigational mapping during cardiac electrophysiological testing does not prolong case duration: A subanalysis from the Cardiac Augmented REality study

Cardiovasc Digit Health J. 2023 Jun 14;4(4):111-117. doi: 10.1016/j.cvdhj.2023.06.003. eCollection 2023 Aug.

Authors

David Bloom¹, David Catherall², Nathan Miller³, Michael K Southworth⁴, Andrew C Glatz¹, Jonathan R Silva^{4

5}, Jennifer N Avari Silva^{1

4

5}

Affiliations

¹ Department of Pediatrics, Division of Cardiology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri.
² School of Medicine, Washington University School of Medicine, St. Louis, Missouri.
³ Pediatric Cardiology/Electrophysiology, St. Louis Children's Hospital, St. Louis, Missouri.
⁴ SentiAR, Inc., St. Louis, Missouri.
⁵ Department of Biomedical Engineering. Washington University in St. Louis, McKelvey School of Engineering, St. Louis, Missouri.

Abstract

Background: CommandEP™ is a mixed reality (MXR) system for cardiac electrophysiological (EP) procedures that provides a real-time 3-dimensional digital image of cardiac geometry and catheter locations. In a previous study, physicians using the system demonstrated improved navigational accuracy. This study investigated the impact of the CommandEP system on EP procedural times compared to the standard-of-care electroanatomic mapping system (EAMS) display.

Objective: The purpose of this retrospective case-controlled analysis was to evaluate the impact of a novel MXR interface on EP procedural times compared to a case-matched cohort.

Methods: Cases from the Cardiac Augmented REality (CARE) study were matched for diagnosis and weight using a contemporary cohort. Procedural time was compared from the roll-in and full implementation cohort. During routine EP procedures, operators performed tasks during the postablation waiting phase, including creation of cardiac geometry and 5-point navigation under 2 conditions: (1) EAMS first; and (2) CommandEP.

Results: From a total of 16 CARE study patients, the 10 full implementation patients were matched to a cohort of 20 control patients (2 controls:1 CARE, matched according to pathology and age/weight). No statistical difference in total case times between CARE study patients vs control group (118 ± 29 minutes vs 97 ± 20 minutes; P = .07) or fluoroscopy times (6 ± 4 minutes vs 7 ± 6 minutes; P = .9). No significant difference in case duration for CARE study patients comparing roll-in vs full-implementation cohort (121 ± 26 minutes vs 118 ± 29 minutes; P = .96). CommandEP wear time during cases was significantly longer in full implementation cases (53 ± 24 minutes vs 24 ± 5 minutes; P = .0009). During creation of a single cardiac geometry, no significant time difference was noted between CommandEP vs EAMS (284 ± 45 seconds vs 268 ± 43 seconds; P = .1) or fluoroscopy use (9 ± 19 seconds vs 6 ± 18 seconds; P = .25). During point navigation tasks, there was no difference in total time (CommandEP 31 ± 14 seconds vs EAMS 28 ± 15 seconds; P = .16) or fluoroscopy time (CommandEP 0 second vs EAMS 0 second).

Conclusion: MXR did not prolong overall procedural time compared to a matched cohort. There was no prolongation in study task completion time. Future studies with experienced CommandEP users directly assessing procedural time and task completion time in a randomized study population would be of interest.

Keywords: Accuracy; Electrophysiology; Fluoroscopy; Mixed reality; Procedural times; Virtual reality.