EP-DAVID : development and improvement of a biomedical simulator for training fellows and expert physicians in the electrophysiology techniques.

Electrophysiology is the study of the electrical activity of the heart and how they affect its function, is critical for detecting and treating cardiac disorders, notably irregular heart rhythms (arrhythmias). Cardiologists specialize in this field, known as Electrophysiologists, must have a thorough comprehension of the electrical system of the heart as well as the ability to traverse and modify it during electrophysiology study (EP). However, because of the risk involved, practicing these procedures on real patients is not a viable choice. Medical simulation-based training tools provide a safe environment for professionals to refine their skills in manipulating electro-catheters during complex heart procedures. This thesis explores the evolution of the EP-DAVID simulator developed by Mouzee srl company. Initially, it featured a 3D printed heart model but has now evolved to generate and propagate Electrocardiogram (ECG) and intracardiac (IC) signals. This addition allows real-time reconstruction of the heart and the study of its electrical conduction system manifested as IC signals. An algorithm was created to generate ECG precordial leads and IC signals, extracting critical features from authentic ECG and literature. This included the P-Wave, QRS-complex, T-wave, duration intervals, and amplitudes, typically measured by ECG machines. Once the ECG waveform was characterized, synchronized IC signals were constructed, requiring a deep understanding of the heart's electrical conduction and IC signals. These waveforms and durations were defined based on literature and expert input, resulting in discrete arrays representing these signals. A transmission module was developed to integrate this functionality into the EP-DAVID simulator, comprising software for ECG and IC signal control, amplitudes, heart rhythm manipulation, and type of arrhythmia simulation. Complementing this was purpose-built hardware for signal transmission in a water-based medium, a requirement dictated by the operational environment. This integration facilitated the use of the electroanatomic mapping system, enabling verification of IC signal propagation and accuracy. Various scenarios, ranging from Sinus Rhythm to complex arrhythmias like Focal Atrial Tachycardias and Ventricular Tachycardias and initial versions of more intricate arrhythmias like Typical Right Atrial Flutter and Left Atrial Fibrillation, were evaluated by electrophysiologic experts, with automated color maps illustrating signal propagation. This enhancement introduced the capacity to modify individual channels in terms of shape and timing and expanded the range of intracardiac channels, allowing for scalability and the creation of new arrhythmias. This significant advancement represents a substantial improvement in electrophysiology training, offering an invaluable opportunity for both fellows and expert physicians professionals to refine their skills in cardiac procedures, ultimately enhancing patient care and safety.