Phantom study of augmented reality framework to assist epicardial punctures.

Purpose: The objective of this study is to evaluate the accuracy of an augmented reality (AR) system in improving guidance, accuracy, and visualization during the subxiphoidal approach for epicardial ablation.

Approach: An AR application was developed to project real-time needle trajectories and patient-specific 3D organs using the Hololens 2. Additionally, needle tracking was implemented to offer real-time feedback to the operator, facilitating needle navigation. The AR application was evaluated through three different experiments: examining overlay accuracy, assessing puncture accuracy, and performing pre-clinical evaluations on a phantom.

Results: The results of the overlay accuracy assessment for the AR system yielded $2.36\pm 2.04\mathrm{mm}$. Additionally, the puncture accuracy utilizing the AR system yielded $1.02\pm 2.41\mathrm{mm}$. During the pre-clinical evaluation on the phantom, needle puncture with AR guidance showed $7.43\pm 2.73\mathrm{mm}$, whereas needle puncture without AR guidance showed $22.62\pm 9.37\mathrm{mm}$.

Conclusions: Overall, the AR platform has the potential to enhance the accuracy of percutaneous epicardial access for mapping and ablation of cardiac arrhythmias, thereby reducing complications and improving patient outcomes. The significance of this study lies in the potential of AR guidance to enhance the accuracy and safety of percutaneous epicardial access.