Background: Interpreting intracardiac electrograms (IEs) is a difficult skill for pediatric cardiology fellows (PCF) to learn. An understanding of how experienced electrophysiologists (EP) process this data may allow for the development of novel training methods for fellows. Eye-tracking technology (ETT), which tracks pupillary movement to gain insight into attention allocation and thought process, has been used for the creation of more efficient educational training programs in other areas within medicine.
Objective: To establish characteristics of novice and expert gaze patterns during IE interpretation using ETT.
Methods: Three pediatric EPs and 2 PCFs viewed IEs of 3 SVT cases using a Tobii Pro Fusion screen-based ETT (250Hz). Total Visualization Time to Diagnosis (TTD), Percentage of time (%T) viewing unique areas of interest (AOI), number of times location of gaze shifted within an AOI (Fixation Count), and the number of times gaze shifted away from and then back to an AOI (Gaze Shifts) were compared between PCFs and EPs.
Results: Although the %T spent looking at each AOI (Surface, HRA, His, CS electrograms) was similar between the groups, PCFs gaze patterns were less efficient with higher fixation counts and number of gaze shifts per AOI. PCFs tended to assess the IEs with horizontal eye movements while EPs assessed the IEs in a more vertical pattern.
Conclusion: This pilot ETT study shows that PCFs and EPs have significant differences in gaze patterns when assessing an IE for arrhythmias. PCFs gaze patterns are overall less efficient with higher fixation counts and gaze shifts. This new understanding of EPs gaze patterns can be used to develop novel training programs for IE interpretation. $$graphic_{ADE1ED0A-6700-42E4-BE40-774F324425D6}$$