Virtually-Driven Closure of the Epicardial Left Atrial Appendage with Augmented Reality and Computational Modelling

Augmented reality (AR) has the potential to complement numerical simulations for enhanced post-processing and bring digital models into the daily clinical practice of healthcare professionals. In complex cardiac anatomies, the decision-making process for device implantation involves challenging evaluations of device positioning and efficacy. This study shows the case of a 79-year-old lady underwent closure of the left atrial appendage (LAA) with the AtriCliop device. Mini-invasive surgical treatment was chosen due to the infeasibility of percutaneous closure caused by anatomical constraints. Epicardial left atrial appendage closure (LAAC) was therefore the only possible solution to mitigate the risk of atrial fibrillation and heart arrest. We developed a framework to generate realistic animation of the LAAC procedure with the AtriClip PRO2 epicardial clip (AtriCure, Inc, Ohio, USA) starting from the computational simulation and ending to augmented reality (AR). This case proves the contribution provided by AR for the visualization of the simulation for accurate placement of the device and the successful execution of the cardiothoracic surgical procedure. We conclude that the synergy between physicians’ expertise and AR can enhance ability to visualize the implications of biomedical device implants in complex cardiac anatomies, benefiting both physicians, simulation experts and patients.