Novel training concept utilizing a real world-like EP simulator

Abstract Background Training in the field of invasive cardiac electrophysiology (EP) is challenging and requires intellectual skills related to the interpretation of intracardiac electrograms. Classic approach to education of young electrophysiologists focused solely on theoretical knowledge and overseen procedures in patients as no real life like simulation of complete diagnostic and therapeutic EP studies was available. Purpose The purpose of this study was to assess a novel tool for EP training based on fully interactive, online simulator providing real clinical experience to the users. Methods EP Simulator replicates EP recording system routinely used in cardiac electrophysiology laboratories and therefore enable easier transition from training to clinical situation. Users are able to access a fully functional system with simulated surface electrocardiogram and intracardiac electrograms mimicking signals recorded by a catheter located at high right atrium, His bundle, coronary sinus, and right ventricular apex. Normal electrophysiology study and the following cardiac arrhythmias are available for simulation: sick sinus syndrome, AV conduction blocks, atrial ectopy, atrial flutter and fibrillation, atrio-ventricular and atrio-ventricular nodal reentrant tachycardia and ventricular tachycardias. Evaluation by 40 electrophysiologists (mean experience 8±6y) from 16 countries was collected via online questionnaire. Results Realism of ECG signals was described as excellent or very good by 90% of responders, realism of intracardial signals by 82.5%. Realism of signal interactions and user experience was judged as excellent or very good by 75% and 70%, respectively. 100% of users agree definitely or mostly that EP Simulator helps to translate theoretical into practical knowledge. 97.5% of responders would include it in EP training programs as it is extremely or very useful for training purposes in opinion of 87.5%. 72.5% of responders think that training on EP simulator can potentially reduce rate of complications. In 87.5% the overall experience of EP simulator was completely or mostly satisfying and it would be recommended by 100% of respondents. Conclusion EP simulator is a feasible tool for training of young electrophysiologist and it may be potentially included in cardiologist curriculum. We should particularly emphasize the positive respondents’ evaluation of EP simulator overall realism. Further systematic evaluation of the training progress is needed.