Virtual Reality in Interventional Electrophysiology

There are 2 principal components to any cardiac intervention: definition of the shape, location, and functional anatomy of a target and precisely located delivery of therapy. As tools for catheter-based electrophysiological (EP) intervention become more potent, it is important to ensure that the technologies used to visualize the target and guide their application are of comparable power. In the digital era, these visualization technologies provide us with a virtual image of the heart. Ideally, this image should be a perfectly accurate, easy to generate, fully transparent to the user, and immediately available for real-time navigation. One approach to understanding the value and appropriate uses of such tools is to assess the degree to which they meet these criteria. Articles in this issue of Circulation by Ector et al1 and Sra et al2 seek to address this task; they document the independent and parallel development a novel approach to anatomic visualization in EP intervention combining fluoroscopy and volume imaging of the heart.Articles pp 3763 and 3769 Traditionally, navigation of catheters for EP study has been performed with fluoroscopic guidance. Fluoroscopy provides a flattened and distorted representation of cardiothoracic anatomy, but the use of multiple projections by a skilled operator allows understanding of anatomy and catheter location in remarkable spatial detail. Building on experience earned over decades of diagnostic catheterization, fluoroscopy has provided excellent and instantaneous feedback for EP catheter manipulation, sufficient to have permitted the development of the field of catheter ablation. This developmental process was facilitated by the serendipitous fact that, for many common arrhythmias, important procedural landmarks such as the His bundle and mitral groove may be identified on fluoroscopy by placement of catheters in easily and visibly reproducible locations.Because fluoroscopy provides a direct, unmodified, and immediate view to the operator, there is no simple …