Traditionally, such imaging techniques have been taught via in-person teaching sessions and hands-on experience. This is a labor- and time-intensive process, consuming healthcare systems’ precious resource of physician & team time away from frontline care duties. Virtual reality training programs have already been developed and rolled out to allow physicians to learn OCT at their own pace through experiential learning in an environment similar to that in which they will use these acquired skills. Future directions will likely embrace augmented reality, to move one step further towards online remote access and thereby enable real-time assistance and case-sharing during cardiac procedures – to effectively join physicians across the world and allow them to be ‘in the room’ together.
3D mapping the heart
Away from coronary interventions, novel imaging techniques have also revolutionized diagnosis and treatment of cardiac arrhythmias (heart rhythm disturbances) – 3-dimensional (3D) mapping technologies combine both anatomical and electrical information to enable accurate diagnosis and targeting of therapy to abolish rhythm disturbances.
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The synthesis of cross-sectional imaging (for example with computed tomography/CT imaging) performed before the procedure with real-time electrical mapping through dedicated catheters reconstruct a virtual “shell” of the heart’s surface where the electrical and tissue information can be displayed in real time. Such imaging needs to take into account a variety of complex and interacting factors, including heart motion, patient breathing, and directionality of the electrical activation simultaneously, through motion-compensated and model-rendering algorithms that provide physicians with a reference to understand the path and spread of electricity over healthy and diseased heart tissue. This, in turn, enables precision in delivery of therapies to mitigate arrhythmia and minimize risk to patients, whilst reducing radiation exposure to both physician and patient.
Like OCT, the 3D mapping technology is being trained and supported remotely through virtual reality, enabling widespread dissemination of the technique without cumbersome in-person training.
Cardiac imaging and structural heart disease
Advancements in imaging have also enabled a new suite of structural heart therapies. Structural heart diseases are primarily defects of the fabric of the heart itself. They may be congenital or acquired and can affect the heart valves as well as the walls between the heart chambers. Such abnormalities can progress with time and impact the heart’s ability to pump blood effectively and efficiently, preventing maintenance of a heathy circulation. Historically, structural heart diseases have been markedly undertreated, in no small part due to the need for open heart surgery to correct these problems. This problem is growing with increasing recognition and diagnosis of structural heart diseases and, with a globally aging population, degenerative (structural heart) diseases are increasing in prevalence. This has driven the development of trans-catheter (minimally invasive) techniques to correct or improve such conditions, expanding treatment opportunities for some patients who may not be candidates for open or conventional surgical treatment.