Total Heart Sim

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The Total Heart Sim EP Stimulator: pace from the HRA, coronary sinus or RV with S1–S4 and burst pacing, induce AVNRT, AVRT, atrial tachycardia, flutter, AF and VT, entrain, deliver a His-refractory PVC and read every beat on a 13-channel recording. No sign-up.

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What you can practise

  • Programmed stimulation. S1 drive trains with up to three extrastimuli (S2–S4), straight pacing and burst pacing from the HRA, CS proximal or distal, low lateral RA, RV apex, RV base and para-Hisian sites, with sensing.
  • AV-nodal physiology. Wenckebach, AV and VA block, refractory periods, decremental conduction, AH jumps and echo beats with dual pathways.
  • SVT mechanisms. Typical AVNRT, orthodromic and antidromic AVRT, concealed and manifest pathways, focal atrial tachycardia.
  • Flutter and its circuits. Typical CTI-dependent flutter, roof-dependent and peri-mitral flutters and vein of Marshall re-entry, with a halo catheter, entrainment and CTI ablation.
  • Fibrillation and VT. AF (including pre-excited AF), focal RVOT VT and scar re-entry VT: induce, overdrive or cardiovert.
  • Measure the recording. A 13-channel recording (II, V1, HRA, His, CS 1–10, RV apex and stimulus marks) with calipers and pause.

Quick how-tos

Induce typical AVNRT
  1. Rhythm: Dual AV-nodal pathways (inducible AVNRT).
  2. Pace HRA, S1 600 ms × 8, S2 300 ms, then press Pace.
  3. Watch the AH jump on the His channel, the echo beat and the narrow-complex tachycardia with near-simultaneous A and V.
  4. Cardiovert to stop it, then find the S2 where the jump appears.
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Entrain typical flutter
  1. Rhythm: Typical atrial flutter (inducible); turn on the Halo catheter.
  2. Burst from CS proximal (S1 240 ms × 12) to induce it.
  3. Pace 20–30 ms faster than the flutter cycle from the CS proximal or HRA and read PPI − TCL.
  4. Turn on CTI ablation and test for bidirectional block.
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His-refractory PVC in SVT
  1. Start orthodromic AVRT or AVNRT.
  2. Set HR-PVC timing (at the His, or just before or after) and press Deliver.
  3. The label reports whether the next A was advanced, delayed, unchanged, or the tachycardia ended without one.
  4. Compare a concealed accessory pathway with AVNRT.
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Read up on each rhythm

AVNRTOrthodromic AVRTAntidromic AVRTWPWFocal atrial tachycardiaTypical flutterPeri-mitral flutterAtrial fibrillationOutflow tract VTScar VT

See every rhythm conduct through the 3D heart, with ICE and fluoroscopy, in the full simulator.

See it live in the simulator for $19

Educational content for clinicians and trainees; not medical advice. The EP Stimulator is a simplified teaching model of conduction, refractoriness and electrograms, not a clinical tool.