## 1 Introduction  
Cardiac arrhythmias encompass a group of pathological conditions in which the patient's heart rhythm and rate are abnormal. They can cause the heart to beat with abnormal frequency and lead to cardiac dysfunction, causing dizziness, fatigue, palpitations, embolic strokes, heart failure, and even cardiac arrest. Arrhythmias are some of the most common cardiovascular pathologies, affecting over 2 million people in the UK alone [1]. Atrial arrhythmias are the most common type worldwide, with atrial fibrillation (AF) being the most prevalent. In 2017, over 37.5 million cases of AF were recorded worldwide, accounting for over 280,000 deaths [2]. In 2014, [PERSON] et al. [3] predicted that the number of AF cases in western countries would more than double by the year 2050. These pathologies stem from arrhythmic substrate forming within the pulmonary veins, atria, coronary sinus and superior vena cava. When pharmacotherapy fails to prevent or control these arrhythmias, patients are referred for cardiac ablation (CA), a 'keyhole' percutaneous interventional procedure in which catheters are used to deliver thermal or non-thermal energy to the myocardial tissue of the cardiac wall, thereby disrupting the arrhythmic substrate and preventing interruption to the tissue conduction and atrial rhythm [4, 5]. This is commonly achieved by delivering localized heat via a radiofrequency ablation catheter. This is carried out in the cardiac catheterization electrophysiology (EP) laboratory and guided by a combination of X-ray fluoroscopy imaging and electroanatomical mapping (EAM) [6]. AF ablation is the most common procedure to be performed in the cardiac EP lab. The right atrium is entered through the femoral venous system. Sheaths are inserted into the femoral vein, usually on the right, due to its proximity to the operator. Catheters are guided into the sheaths and then through the vein up to the inferior vena cava to reach the right atrium and, via a sheath already across the atrial septum, cross into the left atrium [6]. With a growing number of cases, healthcare systems are under pressure to train more operators. Conventional CA training is based on the master-apprentice model during procedures performed on patients [7]. Simulators have been proven to augment electrophysiology training, with direct benefits to patients, especially in early-stage training. [PERSON] et al. [7] used the electrophysiology simulator Procedicus VIST G7 (Mentice AB, Gothenburg, Sweden) to assess the placement of electrophysiological catheters before and after simulator training. The use of simulators in training not only reduced procedural time, but also reduced the trainees' need for prolonged visual feedback, ultimately reducing X-ray exposure time during the procedures. Using the same simulator, another study compared conventional training to simulator-based training in transeptal puncture (TSP) [8]. Two groups of students were trained separately and later assessed on their performance. Simulation practice proved more efficient, reducing training time from 30 days to 4 days. The ANGIO Mentor (Surgical Science, Gothenborg, Sweden) systems are arguably the most versatile cardiovascular interventional simulators on the market today [9]. They are hybrid systems, meaning they have a physical component and a virtual reality component. They consist of blocks, with an insertable replica catheter that can be manipulated by the operator similarly to real ones. The blocks connect to computers, allowing the users to visualize simulated fluoroscopic images, as well as physiological values [10, 11]. The simulator allows for full control of virtual C-arm fluoroscopy, virtual ultrasound, and a virtual computerized tomography (CT). This system can recreate numerous cardiovascular interventional procedures, including EAM and TSP. The price of the ANGIO Mentor ranges between GBP 60,000 and GBP 138,000, and individual procedure modules (such as the ones for EAM and TPS) cost between GBP 5000 and GBP 15,000 [10, 11].