Virtual reality lead extraction as a method for training new physicians: A pilot study

Melanie Maytin, Thomas P. Daily, Roger Carrillo

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background It is estimated that the demand for transvenous lead extraction (TLE) has reached an annual extraction rate of nearly 24,000 patients worldwide. Despite technologic advances, TLE still has the potential for significant morbidity and mortality. Complication rates with TLE directly parallel operator experience. However, obtaining adequate training during and postfellowship can be difficult. Given the potential for catastrophic complications and the steep learning curve (up to 300 cases) associated with this procedure, we sought to validate a virtual reality (VR) lead extraction simulator as an innovative training and evaluation tool for physicians new to TLE. Methods We randomized eight electrophysiology fellows to VR simulator versus conventional training. We compared procedural skill competency between the groups using simulator competency, tactile measurements, markers of proficiency and attitudes, and cognitive abilities battery. Results Practical skills and simulator complications differed significantly between the VR simulator and conventional training groups. The VR simulator group executed patient preparation and procedure performance better than the conventional group (P < 0.01). All four fellows randomized to conventional training experienced a simulator complication (two superior vena cava [SVC] tears, three right ventricle [RV] avulsions) versus one fellow in the VR simulator group (one SVC tear) (P = 0.02). Tactile measurements revealed a trend toward excess pushing versus pulling forces among the conventionally trained group. The time for lead removal was also significantly higher in the conventional training group (12.46 minutes vs 5.54 minutes, P = 0.02). There was no significant difference in baseline or posttraining cognitive ability. Conclusions We contend that the implementation of alternative training tools such as a VR simulation model will improve physician training and allow for an innovative pathway to assess the achievement of competency.

Original languageEnglish (US)
Pages (from-to)319-325
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume38
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Physicians
Aptitude
Superior Vena Cava
Touch
Learning Curve
Electrophysiology
Heart Ventricles
Lead
Morbidity
Mortality

Keywords

  • ICD
  • lead extraction
  • lead management
  • medical simulation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Virtual reality lead extraction as a method for training new physicians : A pilot study. / Maytin, Melanie; Daily, Thomas P.; Carrillo, Roger.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 38, No. 3, 01.03.2015, p. 319-325.

Research output: Contribution to journalArticle

Maytin, Melanie ; Daily, Thomas P. ; Carrillo, Roger. / Virtual reality lead extraction as a method for training new physicians : A pilot study. In: PACE - Pacing and Clinical Electrophysiology. 2015 ; Vol. 38, No. 3. pp. 319-325.
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