Virtual reality - a reality for the electrophysiologist?

Dr. Alexander Carpenter (Specialist Registrar in Cardiology, Severn Deanery)

carpenter.alexander@gmail.com


Introduction

The emerging market in virtual reality (VR) is as impressive in its realism as its rapid growth, with fast-paced technological developments(1) matched by predictions that the VR industry could be generating up to $150bn revenue by 2020(2) with major industry players such as Facebook, Sony, HTC and Microsoft investing heavily.

Virtual reality refers to hardware that attempts to immerse the user in a realistic environment. This has gone through several iterations over the years, from “3D glasses” utilising red/blue filters to more recent sophisticated “3D television” which provide each eye with a more realistic, slightly adjacent perspective to simulate depth perception. The current generation of devices attempt to combine this stereoscopic vision with highly sensitive movement tracking and stereo sound. This is brought together in a virtual reality headset, which the user wears, providing sound and visual input from compatible devices. What the user sees is ‘replaced’ by the virtual environment, and the user is able to explore this environment in a realistic way simply by moving their head and looking around.

While these devices will no doubt be received popularly in the entertainment and social networking realms, they may have important potential uses in the world of cardiology, or indeed electrophysiology. We already suspect that simulation training in the medical profession is a very good thing(3). Within the past decade there have been small studies exploring virtual reality as a training tool in the fields of surgery(4), interventional radiology(5) and interventional cardiology(6,7), albeit using older forms of technology.


Safety - training in the virtual lab

Simulation training is developing as a tool for training cardiologists within the United Kingdom (UK) with several regions offering courses for junior trainees(8,9). These tend to use realistic environments, often with controllable resuscitation dummies, remotely manipulated monitoring screens with or without angiography simulators. The use of virtual reality could in many ways complement these situations, potentially reducing the technical and staffing requirements by immersing the user in a virtual environment. This could make simulation training more accessible for those without ready access to high-fidelity simulation environments. It could also be used to faithfully recreate emergency situations which are difficult to simulate with conventional techniques due to the limitations of using actors, or simulation dummies. The use of haptic technology – that is, devices which can recognise movement in space and provide force-feedback(10,11) – could simulate interactions with procedural equipment, patients or environments.


Mapping and ablation

Electrophysiology as a speciality lends itself well to the benefits of VR – as a highly visual field, technology which more accurately represents the spatial arrangement of anatomy and pathology could bring benefits both in terms of simulation training but equally for day-to-day clinical use. Indeed, recent hardware and software advances have produced sophisticated electroanatomical mapping systems, which can generate complex anatomical and functional models, map arrhythmia and even combine this with information gained from other non-invasive imaging modalities(12). These technologies are currently constrained however by the necessity of projecting three-dimensional models onto two-dimensional display monitors. One could envisage an electrophysiologist able, via a VR headset integrated with mapping technology, to visualise in three dimensions the structures of interest, in real time. Controllers with haptic feedback could be used to guide contact force used. The viewpoint could be modified as appropriate, shared among operators and even transmitted remotely.


Telemedicine - EP at arm’s length

Small proof-of-concept studies have demonstrated the feasibility of remotely-controlled procedures in the surgical world, with urologists performing laparascopic procedures, via computer, on patients in a different continent(13). Currently EP procedures, in particular those involving complex techniques, are often performed in a limited number of high-volume centres, often, in the UK, based in large cities. Development is apace of robotic systems to assist with mapping and ablation of arrhythmia(14). VR, combined with telemedicine could enable skilled operators to perform, supervise or assist with procedures remotely, increasing opportunities for collaboration and dissemination of skills and best practise.


Conclusion

The next decade may well see a seismic shift with the emergence of virtual reality in the world of media and entertainment. As a group of clinicians we should explore the potential ways in which we can use this technology to enhance our practise – not only in terms of simulation training – but harnessing its power to improve our procedural capabilities and outcomes.

No conflicts of interest or funding sources to declare.


References

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14.  Shurrab M, Schilling R, Gang E, Khan EM, Crystal E. Robotics in invasive cardiac electrophysiology. Expert Rev Med Devices. 2014;11:375–381.


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