Volume 9, Issue 8, Pages (August 2012)

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Volume 9, Issue 8, Pages 1280-1285 (August 2012) Simulator training reduces radiation exposure and improves trainees' performance in placing electrophysiologic catheters during patient-based procedures Roberto De Ponti, MD, FHRS, Raffaella Marazzi, MD, Lorenzo A. Doni, MD, Claudio Tamborini, MD, Sergio Ghiringhelli, MD, Jorge A. Salerno-Uriarte, MD Heart Rhythm Volume 9, Issue 8, Pages 1280-1285 (August 2012) DOI: 10.1016/j.hrthm.2012.04.015 Copyright © 2012 Heart Rhythm Society Terms and Conditions

Figure 1 Study flow chart. CS = coronary sinus; EP = electrophysiology; His = His-bundle area; HRA = high right atrium; RVA = right ventricular apex. Heart Rhythm 2012 9, 1280-1285DOI: (10.1016/j.hrthm.2012.04.015) Copyright © 2012 Heart Rhythm Society Terms and Conditions

Figure 2 Electrophysiology simulator consisting of the haptic device (front) and a laptop computer with dedicated software (back). Magnifications of the venous ports simulating subclavian access and right femoral access are shown in the left and right insets, respectively. Heart Rhythm 2012 9, 1280-1285DOI: (10.1016/j.hrthm.2012.04.015) Copyright © 2012 Heart Rhythm Society Terms and Conditions

Figure 3 Simulator screen showing virtual fluoroscopy in the anteroposterior view (top) and tracings in sweeping mode (bottom). A: Catheters are not yet placed. The three white dots indicate the position of the high right atrium (upper left), His-bundle area (center), and right ventricular apex (lower right). The white spot behind the His-bundle area indicates the fossa ovalis, used in the transseptal puncture module. Visualization of these markers can be enabled or disabled by the trainee or the tutor. B: Catheters are placed in the coronary sinus and His-bundle area. Intracavitary recordings from these two sites are shown. Heart Rhythm 2012 9, 1280-1285DOI: (10.1016/j.hrthm.2012.04.015) Copyright © 2012 Heart Rhythm Society Terms and Conditions

Figure 4 Mean values of overall fluoroscopy time per patient for placing all catheters before and after simulator training. Values are expressed in minutes. Vertical lines indicate ranges. Heart Rhythm 2012 9, 1280-1285DOI: (10.1016/j.hrthm.2012.04.015) Copyright © 2012 Heart Rhythm Society Terms and Conditions

Figure 5 Display of the amount of help (A–C) and the fluoroscopy time (B–D) before and after simulator training for each individual positioning in the coronary sinus (A, B) and His-bundle area (C, D). Lines connect the parameter value of the positioning before simulator training with that of the corresponding positioning (first, second, and third) after simulator training. The amount of help is given on a scale from 0–3 (see Table 1). Fluoroscopy time is given in seconds. In panels B and D, an X represents failed placement before simulator training. Heart Rhythm 2012 9, 1280-1285DOI: (10.1016/j.hrthm.2012.04.015) Copyright © 2012 Heart Rhythm Society Terms and Conditions