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Al-Khatib SM, Singh JP, Ghanbari H, McManus DD, Deering TF, Avari Silva JN, Mittal S, Krahn A, Hurwitz JL. The potential of artificial intelligence to revolutionize health care delivery, research, and education in cardiac electrophysiology. Heart Rhythm 2024; 21:978-989. [PMID: 38752904 DOI: 10.1016/j.hrthm.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 06/01/2024]
Abstract
The field of electrophysiology (EP) has benefited from numerous seminal innovations and discoveries that have enabled clinicians to deliver therapies and interventions that save lives and promote quality of life. The rapid pace of innovation in EP may be hindered by several challenges including the aging population with increasing morbidity, the availability of multiple costly therapies that, in many instances, confer minor incremental benefit, the limitations of healthcare reimbursement, the lack of response to therapies by some patients, and the complications of the invasive procedures performed. To overcome these challenges and continue on a steadfast path of transformative innovation, the EP community must comprehensively explore how artificial intelligence (AI) can be applied to healthcare delivery, research, and education and consider all opportunities in which AI can catalyze innovation; create workflow, research, and education efficiencies; and improve patient outcomes at a lower cost. In this white paper, we define AI and discuss the potential of AI to revolutionize the EP field. We also address the requirements for implementing, maintaining, and enhancing quality when using AI and consider ethical, operational, and regulatory aspects of AI implementation. This manuscript will be followed by several perspective papers that will expand on some of these topics.
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Affiliation(s)
- Sana M Al-Khatib
- Duke Clinical Research Institute, Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
| | - Jagmeet P Singh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hamid Ghanbari
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David D McManus
- Department of Medicine, University of Massachusetts Chan Medical School and UMass Memorial Health, Boston, Massachusetts
| | - Thomas F Deering
- Piedmont Heart of Buckhead Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Jennifer N Avari Silva
- Division of Pediatric Cardiology, Washington University School of Medicine, Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | | | - Andrew Krahn
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Narayan SM, Wan EY, Andrade JG, Avari Silva JN, Bhatia NK, Deneke T, Deshmukh AJ, Chon KH, Erickson L, Ghanbari H, Noseworthy PA, Pathak RK, Roelle L, Seiler A, Singh JP, Srivatsa UN, Trela A, Tsiperfal A, Varma N, Yousuf OK. Visions for digital integrated cardiovascular care: HRS Digital Health Committee perspectives. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:37-49. [PMID: 38765620 PMCID: PMC11096652 DOI: 10.1016/j.cvdhj.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | | | | | | | | | | | - Ki H Chon
- University of Connecticut, Storrs, Connecticut
| | | | | | | | | | - Lisa Roelle
- Washington University School of Medicine, Saint Louis, Missouri
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Anthony Trela
- Lucile Packard Children's Hospital, Palo Alto, California
| | - Angela Tsiperfal
- Stanford Arrhythmia Service, Stanford Healthcare, Palo Alto, California
| | | | - Omair K Yousuf
- Inova Heart and Vascular Institute; Carient Heart and Vascular; and University of Virginia Health, Fairfax, Virginia
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Tsai TY, Onuma Y, Złahoda-Huzior A, Kageyama S, Dudek D, Wang Q, Lim RP, Garg S, Poon EKW, Puskas J, Ramponi F, Jung C, Sharif F, Khokhar AA, Serruys PW. Merging virtual and physical experiences: extended realities in cardiovascular medicine. Eur Heart J 2023; 44:3311-3322. [PMID: 37350487 PMCID: PMC10499546 DOI: 10.1093/eurheartj/ehad352] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/27/2023] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
Technological advancement and the COVID-19 pandemic have brought virtual learning and working into our daily lives. Extended realities (XR), an umbrella term for all the immersive technologies that merge virtual and physical experiences, will undoubtedly be an indispensable part of future clinical practice. The intuitive and three-dimensional nature of XR has great potential to benefit healthcare providers and empower patients and physicians. In the past decade, the implementation of XR into cardiovascular medicine has flourished such that it is now integrated into medical training, patient education, pre-procedural planning, intra-procedural visualization, and post-procedural care. This review article discussed how XR could provide innovative care and complement traditional practice, as well as addressing its limitations and considering its future perspectives.
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Affiliation(s)
- Tsung-Ying Tsai
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Xitun District, Taichung 40705, Taiwan
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Adriana Złahoda-Huzior
- Department of Measurement and Electronics, AGH University of Science and Technology, al. A. Mickiewicza 30, 30-059 Kraków, Poland
| | - Shigetaka Kageyama
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Dariusz Dudek
- Interventional Cardiology Unit, Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola RA, Italy
- Center of Digital Medicine and Robotics, Jagiellonian University Medical College, Świętej Anny 12, 31-008 Kraków, Poland
| | - Qingdi Wang
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Ruth P Lim
- Department of Radiology and Surgery (Austin), Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 161 Barry St, Carlton VIC 3010, Australia
- Department of Radiology, Austin Health, 145 Studley Rd, Heidelberg VIC 3084, Australia
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn BB1 2RB, UK
| | - Eric K W Poon
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, 419 W 114th St, New York, NY 10025, United States
| | - Fabio Ramponi
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, 419 W 114th St, New York, NY 10025, United States
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Faisal Sharif
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Arif A Khokhar
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London W12 0HS, UK
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, University Road, Galway H91 TK33, Ireland
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Bloom D, Catherall D, Miller N, Southworth MK, Glatz AC, Silva JR, Avari Silva JN. Use of a mixed reality system for navigational mapping during cardiac electrophysiological testing does not prolong case duration: A subanalysis from the Cardiac Augmented REality study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2023; 4:111-117. [PMID: 37600447 PMCID: PMC10435945 DOI: 10.1016/j.cvdhj.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Background 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. Objective 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. Methods 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. Results 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; P = .07) or fluoroscopy times (6 ± 4 minutes vs 7 ± 6 minutes; P = .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; P = .96). CommandEP wear time during cases was significantly longer in full implementation cases (53 ± 24 minutes vs 24 ± 5 minutes; P = .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; P = .1) or fluoroscopy use (9 ± 19 seconds vs 6 ± 18 seconds; P = .25). During point navigation tasks, there was no difference in total time (CommandEP 31 ± 14 seconds vs EAMS 28 ± 15 seconds; P = .16) or fluoroscopy time (CommandEP 0 second vs EAMS 0 second). Conclusion 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.
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Affiliation(s)
- David Bloom
- Department of Pediatrics, Division of Cardiology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - David Catherall
- School of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Nathan Miller
- Pediatric Cardiology/Electrophysiology, St. Louis Children’s Hospital, St. Louis, Missouri
| | | | - Andrew C. Glatz
- Department of Pediatrics, Division of Cardiology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Jonathan R. Silva
- SentiAR, Inc., St. Louis, Missouri
- Department of Biomedical Engineering. Washington University in St. Louis, McKelvey School of Engineering, St. Louis, Missouri
| | - Jennifer N. Avari Silva
- Department of Pediatrics, Division of Cardiology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri
- SentiAR, Inc., St. Louis, Missouri
- Department of Biomedical Engineering. Washington University in St. Louis, McKelvey School of Engineering, St. Louis, Missouri
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Yuan J, Hassan SS, Wu J, Koger CR, Packard RRS, Shi F, Fei B, Ding Y. Extended reality for biomedicine. NATURE REVIEWS. METHODS PRIMERS 2023; 3:15. [PMID: 37051227 PMCID: PMC10088349 DOI: 10.1038/s43586-023-00208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Extended reality (XR) refers to an umbrella of methods that allows users to be immersed in a three-dimensional (3D) or a 4D (spatial + temporal) virtual environment to different extents, including virtual reality (VR), augmented reality (AR), and mixed reality (MR). While VR allows a user to be fully immersed in a virtual environment, AR and MR overlay virtual objects over the real physical world. The immersion and interaction of XR provide unparalleled opportunities to extend our world beyond conventional lifestyles. While XR has extensive applications in fields such as entertainment and education, its numerous applications in biomedicine create transformative opportunities in both fundamental research and healthcare. This Primer outlines XR technology from instrumentation to software computation methods, delineating the biomedical applications that have been advanced by state-of-the-art techniques. We further describe the technical advances overcoming current limitations in XR and its applications, providing an entry point for professionals and trainees to thrive in this emerging field.
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Affiliation(s)
- Jie Yuan
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, United States
| | - Sohail S. Hassan
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, United States
| | - Jiaojiao Wu
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Casey R. Koger
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, United States
| | - René R. Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
- Ronald Reagan UCLA Medical Center, Los Angeles, CA United States
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, United States
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Baowei Fei
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, United States
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, United States
- Center for Imaging and Surgical Innovation, The University of Texas at Dallas, Richardson, TX, United States
| | - Yichen Ding
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, United States
- Center for Imaging and Surgical Innovation, The University of Texas at Dallas, Richardson, TX, United States
- Hamon Center for Regenerative Science and Medicine, UT Southwestern Medical Center, Dallas, TX, United States
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Bloom D, K Southworth M, R Silva J, N Avari Silva J. The Expanding Uses of Medical Extended Reality in the Cardiac
Catheterization Laboratory: Pre-procedural Planning,
Intraprocedural Guidance, and Intraprocedural Navigation. US CARDIOLOGY REVIEW 2022. [DOI: 10.15420/usc.2021.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The use of innovative imaging practices in the field of interventional cardiology and electrophysiology has led to significant progress in both diagnostic and therapeutic capabilities. 3D reconstructions of 2D images allows a proceduralist to develop a superior understanding of patient anatomy. Medical extended reality (MXR) technologies employ 3D interactive images for the user to improve depth perception and spatial awareness. Although MXR procedural navigation is a relatively new concept, the potential for use within interventional cardiology and EP is significant with the eventual goal of improving patient outcomes and reducing patient harm. This review article will discuss the current landscape of MXR use in the catheterization lab including pre-procedural planning, intraprocedural planning and intraprocedural guidance in diagnostic cardiac catheterization, valvar and coronary interventions, electrophysiology studies, and device implants.
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Affiliation(s)
- David Bloom
- Division of Pediatric Cardiology, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | | | | | - Jennifer N Avari Silva
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO
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Tarabanis C, Klapholz J, Zahid S, Jankelson L. A systematic review of the use of 3D printing in left atrial appendage occlusion procedures. J Cardiovasc Electrophysiol 2022; 33:2367-2374. [PMID: 35989544 DOI: 10.1111/jce.15658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/09/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022]
Abstract
The placement of a left atrial appendage occlusion (LAAO) device can be a technically challenging transcatheter-based procedure. Key challenges include accurate pre-procedural device sizing and proper device positioning at the LAA ostium to ensure sufficient device anchoring and avoid peri-device leaks. To address these challenges, 3D printing (3DP) of LAA models has recently emerged in the literature, first being described in 2015. We present a review of the benefits and drawbacks of employing this technology for LAAO procedures. Pre-procedurally the use of 3DP can consistently and accurately determine LAAO device size over standard of care approaches. Intra-procedurally 3DP's impact entailed a statistically significant decrease in the number of devices used per procedure, as well as in the fluoroscopic time and dose. Post-procedurally, there is some evidence that 3DP could reduce the rate of peri-device leaks, with limited data on its effect on complication rates. Based on existing evidence, we recommend the focused application of 3DP to cases of complex LAA anatomy and for the training of proceduralists. Lastly, we address the emergence of next generation LAAO devices and AR/VR systems that could limit even this narrow window of clinical benefit afforded by 3DP. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Constantine Tarabanis
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Jonah Klapholz
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Sohail Zahid
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
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Bloom D, Colombo JN, Miller N, Southworth MK, Andrews C, Henry A, Orr WB, Silva JR, Avari Silva JN. Early preclinical experience of a mixed reality ultrasound system with active GUIDance for NEedle-based interventions: The GUIDE study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:232-240. [PMID: 36310686 PMCID: PMC9596321 DOI: 10.1016/j.cvdhj.2022.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Use of ultrasound (US) to facilitate vascular access has increased compared to landmark-based procedures despite ergonomic challenges and need for extrapolation of 2-dimensional images to understand needle position. The MantUS™ system (Sentiar, Inc.,) uses a mixed reality (MxR) interface to display US images and integrate real-time needle tracking. Objective The purpose of this prospective preclinical study was to evaluate the feasibility and usability of MantUS in a simulated environment. Methods Participants were recruited from pediatric cardiology and critical care. Access was obtained in 2 vascular access training models: a femoral access model and a head and neck model for a total of 4 vascular access sites under 2 conditions—conventional US and MantUS. Participants were randomized for order of completion. Videos were obtained, and quality of access including time required, repositions, number of attempts, and angle of approach were quantified. Results Use of MantUS resulted in an overall reduction in number of needle repositions (P = .03) and improvement in quality of access as measured by distance (P <.0001) and angle of elevation (P = .006). These findings were even more evident in the right femoral vein (RFV) access site, which was a simulated anatomic variant with a deeper more oblique vascular course. Use of MantUS resulted in faster time to access (P = .04), fewer number of both access attempts (P = .02), and number of needle repositions (P <.0001) compared to conventional US. Postparticipant survey showed high levels of usability (87%) and a belief that MantUS may decrease adverse outcomes (73%) and failed access attempts (83%). Conclusion Use of MantUS improved vascular access among all comers, including the quality of access. This improvement was even more notable in the vascular variant (RFV). MantUS readily benefited users by providing improved spatial understanding. Further development of MantUS will focus on improving user interface and experience, with larger clinical usage and in-human studies.
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Affiliation(s)
- David Bloom
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jamie N. Colombo
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Nathan Miller
- Pediatric Electrophysiology Laboratory, St. Louis Children’s Hospital, St. Louis, Missouri
| | | | | | | | - William B. Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jonathan R. Silva
- Sentiar, Inc., St. Louis, Missouri
- Department of Biomedical Engineering, Washington University McKelvey School of Engineering, St. Louis, Missouri
| | - Jennifer N. Avari Silva
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Sentiar, Inc., St. Louis, Missouri
- Department of Biomedical Engineering, Washington University McKelvey School of Engineering, St. Louis, Missouri
- Address reprint requests and correspondence: Dr Jennifer N. Avari Silva, Division of Pediatric Cardiology, Washington University School of Medicine, 1 Children’s Place, CB 8116 NWT, St. Louis, MO 63110.; OR Dr Jonathan R. Silva, Department of Biomedical Engineering, Washington University McKelvey School of Engineering, 1 Brookings Place, St. Louis, MO 63130.
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Orr WB, Colombo JN, Roberts B, Silva JNA, Balzer D. Incorporation of the CardioMEMS™ System During an Exercise Physiology Test in a Pediatric Congenital Heart Disease Patient Contributing to Medical Decision-Making. Pediatr Cardiol 2022; 43:695-699. [PMID: 34668991 DOI: 10.1007/s00246-021-02758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
Exercise testing among the pediatric congenital heart disease population continues to transform and expand the way patients are evaluated and managed. We describe a case where a stress echocardiogram was performed while successfully collecting data from a previously implanted CardioMEMS™ HF system which helped guide decision-making.
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Affiliation(s)
- William B Orr
- Division of Cardiology, Department of Pediatrics, One Children's Place, MSC 8116-43-08, St. Louis, MO, 63110, USA.
| | - Jamie N Colombo
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, USA
| | - Bayley Roberts
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, USA
| | - Jennifer N Avari Silva
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, USA
| | - David Balzer
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, USA
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Silva JNA, Southworth MK, Andrews CM, Privitera MB, Henry AB, Silva JR. Design Considerations for Interacting and Navigating with 2 Dimensional and 3 Dimensional Medical Images in Virtual, Augmented and Mixed Reality Medical Applications. VIRTUAL, AUGMENTED AND MIXED REALITY : 13TH INTERNATIONAL CONFERENCE, VAMR 2021, HELD AS PART OF THE 23RD HCI INTERNATIONAL CONFERENCE, HCII 2021, VIRTUAL EVENT, JULY 24-29, 2021, PROCEEDINGS. VAMR (CONFERENCE) (13TH : 2021 : ONLINE) 2021; 12770:117-133. [PMID: 35079751 PMCID: PMC8786214 DOI: 10.1007/978-3-030-77599-5_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The extended realities, including virtual, augmented, and mixed realities (VAMR) have recently experienced significant hardware improvement resulting in an expansion in medical applications. These applications can be classified by the target end user (for instance, classifying applications as patient-centric, physician-centric, or both) or by use case (for instance educational, diagnostic tools, therapeutic tools, or some combination). When developing medical applications in VAMR, careful consideration of both the target end user and use case must heavily influence design considerations, particularly methods and tools for interaction and navigation. Medical imaging consists of both 2-dimensional and 3-dimensional medical imaging which impacts design, interaction, and navigation. Additionally, medical applications need to comply with regulatory considerations which will also influence interaction and design considerations. In this manuscript, the authors explore these considerations using three VAMR tools being developed for cardiac electrophysiology procedures.
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Affiliation(s)
- Jennifer N Avari Silva
- Department of Pediatrics, Cardiology, Washington University in St Louis, School of Medicine, St Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St Louis, McKelvey School of Engineering, St Louis, MO, USA
- SentiAR, Inc, St Louis, MO, USA
| | | | | | | | | | - Jonathan R Silva
- Department of Biomedical Engineering, Washington University in St Louis, McKelvey School of Engineering, St Louis, MO, USA
- SentiAR, Inc, St Louis, MO, USA
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11
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Prakosa A, Southworth MK, Avari Silva JN, Silva JR, Trayanova NA. Impact of augmented-reality improvement in ablation catheter navigation as assessed by virtual-heart simulations of ventricular tachycardia ablation. Comput Biol Med 2021; 133:104366. [PMID: 33836448 PMCID: PMC8169616 DOI: 10.1016/j.compbiomed.2021.104366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recently, an augmented reality (AR) solution allows the physician to place the ablation catheter at the designated lesion site more accurately during cardiac electrophysiology studies. The improvement in navigation accuracy may positively affect ventricular tachycardia (VT) ablation termination, however assessment of this in the clinic would be difficult. Novel personalized virtual heart technology enables non-invasive identification of optimal lesion targets for infarct-related VT. This study aims to evaluate the potential impact of such catheter navigation accuracy improvement in virtual VT ablations. METHODS 2 MRI-based virtual hearts with 2 in silico induced VTs (VT 1, VT 2) were included. VTs were terminated with virtual "ground truth" endocardial ablation lesions. 106 navigation error values that were previously assessed in a clinical study evaluating the improvement of ablation catheter navigation accuracy guided with AR (53 with, 53 without) were used to displace the "ground truth" ablation targets. The corresponding ablations were simulated based on these errors and VT termination for each simulation was assessed. RESULTS In 54 VT 1 ablation simulations, smaller error with AR significantly resulted in more VT termination (25) compared to the error without AR (16) (P < 0.01). In 52 VT 2 ablation simulations, no significant difference was observed from error with (11) and without AR (13) (P = 0.58). The substrate characteristic may impact the effect of improved accuracy to an improved VT termination. CONCLUSION Virtual heart shows that the increased catheter navigation accuracy provided by AR guidance can affect the VT termination.
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Affiliation(s)
- Adityo Prakosa
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Jennifer N Avari Silva
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jonathan R Silva
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
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12
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Bruckheimer E, Goreczny S. Advanced imaging techniques to assist transcatheter congenital heart defects therapies. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Andrews CM, Henry AB, Soriano IM, Southworth MK, Silva JR. Registration Techniques for Clinical Applications of Three-Dimensional Augmented Reality Devices. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2020; 9:4900214. [PMID: 33489483 PMCID: PMC7819530 DOI: 10.1109/jtehm.2020.3045642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022]
Abstract
Many clinical procedures would benefit from direct and intuitive real-time visualization of anatomy, surgical plans, or other information crucial to the procedure. Three-dimensional augmented reality (3D-AR) is an emerging technology that has the potential to assist physicians with spatial reasoning during clinical interventions. The most intriguing applications of 3D-AR involve visualizations of anatomy or surgical plans that appear directly on the patient. However, commercially available 3D-AR devices have spatial localization errors that are too large for many clinical procedures. For this reason, a variety of approaches for improving 3D-AR registration accuracy have been explored. The focus of this review is on the methods, accuracy, and clinical applications of registering 3D-AR devices with the clinical environment. The works cited represent a variety of approaches for registering holograms to patients, including manual registration, computer vision-based registration, and registrations that incorporate external tracking systems. Evaluations of user accuracy when performing clinically relevant tasks suggest that accuracies of approximately 2 mm are feasible. 3D-AR device limitations due to the vergence-accommodation conflict or other factors attributable to the headset hardware add on the order of 1.5 mm of error compared to conventional guidance. Continued improvements to 3D-AR hardware will decrease these sources of error.
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Affiliation(s)
- Christopher M. Andrews
- Department of Biomedical EngineeringWashington University in St Louis, McKelvey School of EngineeringSt LouisMO63130USA
- SentiAR, Inc.St. LouisMO63108USA
| | | | | | | | - Jonathan R. Silva
- Department of Biomedical EngineeringWashington University in St Louis, McKelvey School of EngineeringSt LouisMO63130USA
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