Virtual Reality May Improve Interventional Cardiology Skills, Says Pilot Study

Deborah Brauser

January 04, 2016

WÜRZBURG, GERMANY — Simulation training may increase the performance of fellows relatively new to interventional cardiology, new research suggests[1].

A pilot study of 18 cardiology fellows in Germany showed that those randomized to receive about 8 hours of mentored virtual-reality (VR) simulator training had a 5.8-point increase from baseline on a graded "skills score" after performing a catheter intervention on a heart-flow model, whereas those randomized to 4.5 hours of lectures had a 6.7-point decrease in skills score (P=0.003 for group comparison).

"Mentored simulation training has the advantage that it trains not only the manual component of PCI, but also the analytical and interpretational part and the fellow's three-dimensional perceptivity," note investigators, led by Dr Wolfram Voelker (University Hospital of Würzburg, Germany).

They add that further research is now needed to assess the effect of this type of training on clinical outcomes. Still, VR training may provide "a solution for the drawbacks of classical teaching methods."

The findings were published online December 16, 2015 in the Journal of Interventional Cardiology.

"Pulsatile Coronary Artery Model" Used

The study participants all had prior experience with performing diagnostic catheterizations (at least 50), but none had performed an interventional procedure "as a primary operator," write the investigators.

"For pre- and postevaluation, the participants performed a coronary intervention on a commercially available pulsatile coronary artery model (CoroSim, Mecora, Aachen, Germany)," they report. "This mechanical flow model provides realistic conditions for PCI."

In the University Hospital of Würzburg cath lab, the model's femoral artery was exposed "with the introducer sheath already in place," note the researchers. "An experienced interventional cardiologist supported the participants in C-arm handling, [and] commercially available guiding catheters, balloons, and wires were used."

In addition to continuous video documentation, X-ray fluoroscope and cine-X-ray coronary angiography were used to document the participants' procedures. Then, three blinded interventionalists assigned a skills score based on 14 performance characteristics on a five-level Likert scale.

The nine participants randomized to simulation-based training received a "standardized curriculum" for VR in interventional cardiology. Each underwent 2.5 hours of mentor-led training on each of three simulators: the Vist-C (Mentice, Gothenburg, Sweden), the CathLabVR (CAE Healthcare, Sarasota, FL), and the AngioMentor Express (Simbionix, Cleveland, OH).

Two expert interventionists gave a detailed, step-by-step, 4.5-hour lecture to the other nine participants (the control group).

Increased Skills

The VR group had an increase in total skills score from 47.2 (out of a 70-point maximum) at baseline to 53.0 during the posttraining evaluation. On the other hand, the control group's total skills score decreased from 50.3 to 43.6.

In addition, four individual items on the Likert Scale showed statistical improvement for the VR group: coronary wire position after balloon insertion (P=0.008 for between-group comparison), balloon-stent exchange technique (P=0.04), wire tip position after exchanging balloon and stent ( P<0.05), and stent positioning (P=0.02).

All participants were given a time limit of 25 minutes for the procedure, which was achieved by all except for two of the control-group members. The VR group had a decrease in mean procedural time from 21.1 minutes at baseline to 19.4 minutes; and the control group had an increase from 17.6 minutes to 20.9 minutes. However, the between-group differences were not deemed significant. There were also no significant differences in contrast volume or fluoroscopy time.

"This might be due to an increased risk awareness, which may have triggered the simulation group participants to a more cautious and careful approach," write the investigators.

They add that, overall, VR training technology was shown to improve "the hand-eye coordination and procedural skills of novices in interventional cardiology."

The study authors report no relevant financial relationships.

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