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Percutaneous epicardial access for epicardial ablation and mapping of cardiac arrhythmias is being performed more and more often. Unfortunately, complications such as injury to surrounding structures have been reported. Despite the current imaging techniques, it is still difficult to guarantee sufficient ablation accuracy. Head-Mounted-Display (HMD) Augmented Reality (AR) overlay and guidance has the potential to reduce the risk of complications. The objective of this study was to evaluate the accuracy and performance of an AR-guided epicardial puncture for catheter ablation of ventricular tachycardia. An AR software tool was designed to render real-time needle trajectories and 3D patient-specific organs. Registration of preoperative data is realized by attaching four AR patterns to the skin of the patient. Needle tracking is realized by attaching one AR pattern to the end of the needle’s base. The ideal trajectory through the pericardial space and patient-specific organs was planned and segmented on preoperative CT. The application’s accuracy was evaluated in a phantom study. Seven operators performed needle puncture with and without the use of the AR system. Placements errors were measured on postprocedural CT. With the use of the proposed AR-based guidance, post procedure CT revealed an error at the puncture site of 3.67±2.78 mm. At the epicardial interface, the error increased to 7.78±2.36 mm. The angle of the actual trajectory deviated on average 4.82±1.48◦ from the planned trajectory. The execution time was on average 34.0 ± 25.1 s, hence introducing no significant delay at an overall superior performance level compared to without AR-guided puncturing. The proposed AR platform has the potential to facilitate percutaneous epicardial access for epicardial ablation and mapping of cardiac arrhythmias by improving needle insertion accuracy.
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