Training of electrophysiologists (EPs) relies mostly on a companionship, where teaching of catheter (CATH) steerability is made on patients (pts) referred for catheter ablation (CA) procedures. While several other domains have established the utility of simulators to speed up learning process, dedicated simulators for EPs based on pts’ true anatomy are lacking.

To speed up the handling of steerable CATH on MRI and CT scan-based 3D heart models to optimize ablation road maps in pts referred for ablation.

ARTS is an Artificial Intelligence and Augmented Reality-based platform comprising two key components: HeARTS and ARTSim. HeARTS is designed to automatically generate 3D heart models from pts’ MRI or CT scans. ARTSim is a CA simulator that utilizes the 3D heart models of the pts for the planning and simulation of CA procedures. This simulator incorporates innovative techniques for digitizing and tracking the motion of a physical CATH in real time and enabling its navigation within a virtual heart. The CATH can be precisely steered to various heart locations. Herein, we report a comparative study of the learning curves for cavotricuspid isthmus (CTI) ablation between three non-EPs and four EPs.

Panel A of the Fig. 1 shows the mannequin used for the simulator, where a real ablation CATH is introduced within the pt's heart through a venous introducer. Panel B shows several views of a pt suffering from a CTI flutter. Note the yellow tags positioned along the CTI that trainees must reach for a duration of 5s (i.e. stability) with a force of 5g (i.e. efficacy) and <30g (i.e. safety) using the CATH shown in panel A. Panel C shows procedural times (min) for non-EP (green) and EP (blue) trainees for the first 5 treated hearts (dark color) compared to the last 5 treated hearts (light color) after 20 simulated CTI procedures (i.e. training phase). Panel D shows that non-EPs displayed a strong and significant reduction in procedural time (from 12.3±7.3 to 4.0±3.7min, P<0.05), whose post-training values became similar to that of EPs (from 5.0±3.7 to 2.8±1.8min, P=ns).

We present ARTS, a realistic CA simulation platform for the training of future EPs that offers all the characteristics of 3D navigation including steerability, stability and force measurements. To the best of our knowledge, this is the first study showing improvement in procedural time for CA of cardiac arrhythmias using a realistic simulator based on pts’ true anatomy.