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. 2025 Jun 23;6(5):1055-1068.
doi: 10.1093/ehjdh/ztaf072. eCollection 2025 Sep.

Catheterization laboratories open the doors for Extended Realities-review of clinical applications in cardiology

Maria Kundzierewicz  1 , Katarzyna Kołodziej  1 , Arif Khokhar  2 , Tsai Tsung-Ying  3 , Artur Leśniak  1 , Pawel Zakrzewski  1 , Hubert Borecki  1 , Ewelina Bohn  1 , Jan Hecko  4   5 , Jaroslav Januska  4 , Daniel Precek  4 , Maciej Stanuch  6   7 , Andrzej Skalski  6   7 , Yoshinobu Onuma  3 , Patrick Serruys  3 , Nico Bruining  8 , Adriana Złahoda-Huzior  1   6 , Dariusz Dudek  9   10
Affiliations

Catheterization laboratories open the doors for Extended Realities-review of clinical applications in cardiology

Maria Kundzierewicz et al. Eur Heart J Digit Health. .

Abstract

The complexity and spatial relationships between vascular and cardiac structures, as well as anatomical diversity, pose a challenge for planning and performing cardiac interventions. Medical imaging, especially precise three-dimensional imaging techniques, plays a key role in the decision-making process. While traditional imaging methods like angiography, echocardiography, computed tomography, and magnetic resonance imaging remain gold standards, they have limitations in representing spatial relationships effectively. To overcome these limitations, advanced techniques such as three-dimensional printing, three-dimensional modelling, and Extended Realities are needed. Focusing on Extended Realities, their main advantages are direct spatial visualization based on medical data, interaction with objects, and immersion in cardiac anatomy. These benefits impact procedural planning and intra-procedural navigation. The following publication presents current applications, benefits, drawbacks, and limitations of Virtual, Augmented, and Mixed Reality technologies in cardiac interventions. The aim of this review is to improve understanding and utilization of the entire spectrum of these innovative tools in clinical practice.

Keywords: 3D imaging; Augmented reality; Cardiac imaging; Extended Realities; Intra-procedural navigation; Mixed reality; Pre-procedural planning; Virtual reality.

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Conflict of interest statement

Conflict of interest: M.K., K.K., A.L., P.Z., H.B., and A.Z.-H. are employees and E.B. is a former employee of Virmed Sp. z o.o. Virmed Sp. z o.o. as a company implements XR solutions into clinical practice, however it does not own and produce any XR product. A.S. and M.S. are employees of MedApp S.A. A.Z.-H. is a former employee of MedApp S.A. D.D. is a former member of the advisory board of MedApp S.A. MedApp S.A. is a company developing XR application: CarnaLife Holo.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Spectrum of Extended Realities (XR): Virtual (VR), Mixed (MR), and Augmented Reality (AR) with their main features.
Figure 2
Figure 2
Graphical explanation of main technical parameter differences among different XR technologies.
Figure 3
Figure 3
Clinical workflow of Extended Realities (XR) data visualization. Post data acquisition, images are reconstructed and transferred either to image storage or directly—to XR application. The application allows users to visualize and interact with the 3D virtual objects via head-mounted displays and dedicated controllers.
Figure 4
Figure 4
Selected example of pre-procedural and postprocedural use of Extended Realities (XR). (A) Evaluation of occluder implantation position post left atrial appendage closure in Mixed Reality using computed tomography images. The view presents left atrial and left atrial appendage cut longitudinally. (B) Result of transcatheter aortic heart valve implantation in Virtual Reality (VR). Valve frame implantation height is presented in the aortic root and left ventricular outflow tract, including the left ventricle blood pool in visualization. (C) Procedural planning based on Mixed Reality-based optical coherence tomography (OCT) data visualization. Vessel dissection shape and distribution are presented to the operator to plan the stenting strategy and perform spatial lumen measurements.
Figure 5
Figure 5
Possibilities of combining Extended Realities (XR) with other technologies—the benefits that can be obtained.
See this image and copyright information in PMC

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