Bloom David, Catherall David, Miller Nathan, Southworth Michael K, Glatz Andrew C, Silva Jonathan R, Avari Silva Jennifer N
Department of Pediatrics, Division of Cardiology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri.
School of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Cardiovasc Digit Health J. 2023 Jun 14;4(4):111-117. doi: 10.1016/j.cvdhj.2023.06.003. eCollection 2023 Aug.
CommandEP™ is a mixed reality (MXR) system for cardiac electrophysiological (EP) procedures that provides a real-time 3-dimensional digital image of cardiac geometry and catheter locations. In a previous study, physicians using the system demonstrated improved navigational accuracy. This study investigated the impact of the CommandEP system on EP procedural times compared to the standard-of-care electroanatomic mapping system (EAMS) display.
The purpose of this retrospective case-controlled analysis was to evaluate the impact of a novel MXR interface on EP procedural times compared to a case-matched cohort.
Cases from the Cardiac Augmented REality (CARE) study were matched for diagnosis and weight using a contemporary cohort. Procedural time was compared from the roll-in and full implementation cohort. During routine EP procedures, operators performed tasks during the postablation waiting phase, including creation of cardiac geometry and 5-point navigation under 2 conditions: (1) EAMS first; and (2) CommandEP.
From a total of 16 CARE study patients, the 10 full implementation patients were matched to a cohort of 20 control patients (2 controls:1 CARE, matched according to pathology and age/weight). No statistical difference in total case times between CARE study patients vs control group (118 ± 29 minutes vs 97 ± 20 minutes; = .07) or fluoroscopy times (6 ± 4 minutes vs 7 ± 6 minutes; = .9). No significant difference in case duration for CARE study patients comparing roll-in vs full-implementation cohort (121 ± 26 minutes vs 118 ± 29 minutes; = .96). CommandEP wear time during cases was significantly longer in full implementation cases (53 ± 24 minutes vs 24 ± 5 minutes; = .0009). During creation of a single cardiac geometry, no significant time difference was noted between CommandEP vs EAMS (284 ± 45 seconds vs 268 ± 43 seconds; = .1) or fluoroscopy use (9 ± 19 seconds vs 6 ± 18 seconds; = .25). During point navigation tasks, there was no difference in total time (CommandEP 31 ± 14 seconds vs EAMS 28 ± 15 seconds; = .16) or fluoroscopy time (CommandEP 0 second vs EAMS 0 second).
MXR did not prolong overall procedural time compared to a matched cohort. There was no prolongation in study task completion time. Future studies with experienced CommandEP users directly assessing procedural time and task completion time in a randomized study population would be of interest.
CommandEP™是一种用于心脏电生理（EP）手术的混合现实（MXR）系统，可提供心脏几何形状和导管位置的实时三维数字图像。在先前的一项研究中，使用该系统的医生显示出导航准确性有所提高。本研究调查了CommandEP系统与标准护理电解剖标测系统（EAMS）显示器相比对EP手术时间的影响。
本回顾性病例对照分析的目的是评估与病例匹配队列相比，新型MXR界面对EP手术时间的影响。
使用当代队列对心脏增强现实（CARE）研究中的病例进行诊断和体重匹配。比较了引入期和全面实施期队列的手术时间。在常规EP手术期间，操作人员在消融后等待阶段执行任务，包括在两种情况下创建心脏几何形状和进行五点导航：（1）先使用EAMS；（2）使用CommandEP。
在CARE研究的16例患者中，10例全面实施的患者与20例对照患者组成的队列进行了匹配（2例对照：1例CARE患者，根据病理和年龄/体重进行匹配）。CARE研究患者与对照组之间的总病例时间（118±29分钟对97±20分钟；P = 0.07）或透视时间（6±4分钟对7±6分钟；P = 0.9）无统计学差异。CARE研究患者中引入期与全面实施期队列的病例持续时间无显著差异（121±26分钟对118±29分钟；P = 0.96）。全面实施病例中CommandEP的佩戴时间明显更长（53±24分钟对24±5分钟；P = 0.0009）。在创建单个心脏几何形状期间，CommandEP与EAMS之间在时间上无显著差异（284±45秒对268±43秒；P = 0.1）或透视使用情况（9±19秒对6±18秒；P = 0.25）。在点导航任务期间，总时间（CommandEP为31±14秒对EAMS为28±15秒；P = 0.16）或透视时间（CommandEP为0秒对EAMS为0秒）没有差异。
与匹配队列相比，MXR没有延长总体手术时间。研究任务完成时间没有延长。未来对经验丰富的CommandEP用户进行研究，在随机研究人群中直接评估手术时间和任务完成时间，将很有意义。
