Background:
Training in the field of invasive cardiac electrophysiology (EP) is challenging and requires intellectual skills related to the interpretation of intracardiac electrograms. Classic approach to education of young electrophysiologists focused solely on theoretical knowledge and overseen procedures in patients as no real life like simulation of complete diagnostic and therapeutic EP studies was available.

The purpose of this study was to develop a novel tool for EP training based on fully interactive, online simulator providing real clinical experience to the users.

Methods and results:
CardiacEPStim replicates EP recording system routinely used in cardiac electrophysiology laboratories and therefore enable easier transition from training to clinical situation. Users are able to access a fully functional system with simulated surface electrocardiogram and intracardiac electrograms mimicking signals recorded by a catheter located at high right atrium (HRA), His bundle (HIS), coronary sinus, and right ventricular apex (RV). For atrial flutter simulation, system display also duodecapolar catheter signals from right atrium. An ablation channel is available in selected scenarios which support ablation procedures. Normal electrophysiology study and the following cardiac arrhythmias are available for simulation: sick sinus syndrome, AV conduction blocks, atrial ectopy, atrial flutter and fibrillation, atrio-ventricular and atrio-ventricular nodal reentrant tachycardia (AVRT and AVNRT) and ventricular tachycardias. Educational content focusing on interpretation of pacing maneuvers and individual signals as well as safety issues and possible complications has been added to selected scenarios.   

Initial evaluation by 6 experienced electrophysiologists was positive and stressed the similarity of simulator with clinical setting both in terms of user experience (UX) and user interface (UI). The quality of the signals was judged as very good/good. Additionally, programed random changes in both timing of signals as well morphology was positively received as it increases the realism. All respondent wished a similar tool would have been available during their training.