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

BACKGROUND CommandEP(TM) is a mixed reality (MXR) system for cardiac electrophysiological (EP) procedures that provides a realtime 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 5.07) or fluoroscopy times (6 +/- 4 minutes vs 7 +/- 6 minutes; P 5.9). No significant difference in case duration for CARE study patients comparing roll-in vs full-implementation cohort (121626 minutes vs 118629 minutes; P5.96). CommandEP wear time during cases was significantly longer in full implementation cases (53 +/- 24 minutes vs 24 +/- 5 minutes; P 5.0009). 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 5.1) or fluoroscopy use (9 +/- 19 seconds vs 6618 seconds; P5.25). During point navigation tasks, there was no difference in total time (CommandEP 31 +/- 14 seconds vs EAMS 28 +/- 15 seconds; P 5.16) 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.