Background: Catheter navigation skills require a combination of hand-eye coordination, fine motor movements and spatial orientation. Despite advances in mapping techniques, fluoroscopic catheter guidance remains an important part of electrophysiology (EP) fellows training. Commercially available simulators are expensive and not readily available in most academic centers.
Objective: To evaluate the feasibility and costs of a procedural simulation for catheter guidance using pre-simulation visualization of 3D virtual heart models and procedural “hands on” simulation using a 3D printed heart model in the EP lab environment.
Methods: Five EP fellows performed 6 simulation cases each: Trans-septal access (TS), left atrial (LA) and right ventricular (RV) mapping at 0 and 24 hrs (N=30). All cases were performed in an EP lab using a 3D printed cardiac model positioned in attitudinal orientation on the EP table, expired catheters and low intensity fluoroscopy (2 FPS).
Results: All fellows improved their procedural times between 1st and 2nd procedures (TS= 10.5 versus 6.8 min, P=0.3; LA= 7.3 versus 4.6 min, P=0.4 and RV= 6.8 versus 4.4 min, P=0.4). Simulation experience questionnaires showed improved spatial orientation and tactile feedback as the key benefits of the training. The simulation procedural costs were 10 USD per model. TS models were single use only, all other were reusable.
Conclusion: Procedural simulation for fluoroscopy based catheter manipulation using 3D printed heart models in an EP lab environment is inexpensive, feasible and facilitates the learning curve for common EP procedures. This technology has the potential for widespread adoption in training programs.