Brief Communication
Feasibility of using the Metaverse as Telecardiology platform: Remote Follow-up of a patient with Vasospastic Angina
https://doi.org/10.21203/rs.3.rs-1800790/v1
This work is licensed under a CC BY 4.0 License
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The metaverse has recently seen a surge of interest among numerous sectors, including healthcare, but it’s potential impact in patient care and disease diagnosis hasn’t been evaluated yet. We conducted the first medical act inside the metaverse by combining a virtual reality metaverse environment with existing telemedicine innovations, in order to perform a clinical and electrocardiographic follow-up of a patient presenting with vasospastic angina.
metaverse
digital health
telemedicine
virtual reality
Since the metaverse has been introduced, there have been ongoing discussions regarding the potential applications to our daily lives and the possible impact on healthcare. (1)(2) Being an interactive virtual environment using augmented reality (AR) and virtual reality (VR) and interacting via digital avatars, the metaverse can be also imagined as a potential telemedicine platform. (3) (4) Since its use for medical purposes has not been investigated yet, we sought to evaluate the feasibility of performing a telecardiology consultation combining the use of the metaverse with telemedical devices. (5)
A digital consultation room combining AR/VR was created inside the Aimedis Avalon metaverse platform (GDPR compliant, CE class I medical device). Patient and doctor were given secured login access account to interact with virtual avatars and an Oculus Quest-2 VR headset. Integration of D-Heart smartphone-based electrocardiograph (portable 12-Lead Smartphone-ECG device) was performed in the virtual room. (6)(7)
A 30 years old obese male patient presented at the emergency department for resolved recurrent episodes of cardiac chest pain at rest, without electrocardiographic conduction or repolarization abnormalities and normal laboratory tests. The echocardiography showed a normal biventricular function with no focal abnormalities. Coronary angiogram excluded the presence of coronary artery disease and showed partial (50–70%) constriction of right coronary artery to acetylcholine intracoronary infusion, suggesting a diagnosis of possible vasospastic angina. (8) The patient was, therefore, discharged under treatment with diltiazem. Since no ECGs were available during the angina episodes, he was provided with the smartphone ECG device, access to metaverse and was instructed to connect for consultation in case of cardiac related symptom.
At day 10 from discharge, the patient experienced palpitations accompanied with general discomfort and subsequently logged into the metaverse where the cardiologist was available. Log in time to the metaverse platform was 4 minutes after the initial symptom. The anamnesis of the episode was collected and he was instructed to auto-record and share the 12-lead ECG, blood pressure and oxygen saturation (Fig. 1). Although clinical and electrocardiographic data were reassuring and consistent with anxiety (comparable ECG, BP 135/93 mmHg, 02 saturation 97%), the physician proposed to seek for medical attention (Video 1, Supplementary Material). Hospital work-up, including laboratory analysis, 12-lead ECG were consistent with the diagnosis provided during the metaverse consultation.
This study reports the first medical act inside the metaverse, demonstrating the feasibility of combining metaverse AR/VR environments with existing telemedicine innovations to potentially empower decentralized medical care. The present remote virtual consultation of a young patient with possible vasospastic angina, supported by clinical and electrocardiographic parameters, proved to be user friendly and easily accessible, receiving positive feedback from both participants. No definitive diagnosis was reached, but remote based follow-up is still ongoing. One of the main limiting factors for the widespread adoption and diffusion of telemedicine has always been the need of several and different platforms for various medical purposes. (9)(10) Given the fact that multiple industries (from high-tech to art and real estate) have started to invest actively in the metaverse, its diffusion and development are predicted to increase exponentially. (11)(12)(13)(14) The key advantage of the metaverse is its ability to function as a widespread certified medical platform, using the blockchain for the encryption of patient data and eventually integrate and interconnect diverse telemedicine innovations. (15) The present infrastructure can potentially introduce new dimensions to the way medical care is delivered, although diverse technological requirements should still be addressed, along with rigorous larger validation studies, to ascertain cost-effectiveness and diagnostic yield. (16)
Aimedis Avalon Metaverse Medical Platform is a 3D application based on the Unreal Engine 5 computer engine developed by Epic Games. It is a client-based solution on Windows and Mac, supporting the latest GPUs including raytracing, spatial audio and VR-headsets. It is GDPR compliant and CE marked Class I medical device. Two pairs of Oculus Quest 2 Virtual Reality Headset with link cable were given to the physician and the patient in order to use them for the metaverse consultation.
D-Heart smartphone-based electrocardiograph, blood pressure monitor and pulse oximetry
D-Heart electrocardiograph is a CE marked Class IIa multiple lead smartphone-based ECG device. The ECG data were transferred via Bluetooth to the smartphone in a medically certified App that enables remote reading and were directly integrated to the Aimedis metaverse platform via App-to-Cloud with an end-to-end cryptography. Blood pressure and oxygen saturation were independently measured by commercially available devices (OMRON M2 upper arm blood pressure monitor, Medisana PM 100 Pulse oximeter) and was shared to the physician during the metaverse virtual consultation.
Ethics
The participant was more than 18 years old and provided explicit and informed consent to data collection and analysis by reading and signing a study-specific participant agreement that informed them about collecting clinical and electrocardiographic parameters and using his avatar for recording and publication purposes. Participant didn't receive monetary compensation for their time and retained the option to have data deleted at any time. The methods were performed in accordance with relevant guidelines and regulations and approved by the University Hospital of Heraklion Institutional Review Board.
Data Availability
The images and video frames generated during this study are available from the corresponding author upon request.
Funding/Support: This study hasn’t received any financial support or funding.
Contributions
IS and NM conceptualized the study, made data analysis and drafted the manuscript. MK and BE provided technical support, Images and Videos. ES, OM, MK and SF contributed to the study design and approved the final manuscript as submitted. ES and MH provided major treatment on the patient, and approved the final manuscript as submitted. All authors contributed to the article and approved the submitted version
Competing interests:
The Authors declare no Competing Non-Financial Interests but the following Competing Financial Interests. Dr Michael Kaldasch MD and Ben El Idrissi reported being shareholders of the Aimedis B.V.Dr Niccolo Maurizi MD and reported being shareholder of the social-vocation start-up D-Heart Biomedical Company.
There is a conflict of interest
Dr Michael Kaldasch MD reported being shareholder and chief executive officer of the Aimedis B.V. No other disclosures were reported. Dr Niccolo Maurizi MD reported being shareholder of the social-vocation start-up D-Heart Biomedical Company.
Video recording showing highlights of the avatar based metaverse consultation inside a virtual hospital
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