Percutaneous epicardial access (PEA), performed on a beating heart under fluoroscopy, enables arrhythmia treatment. However, advancing a needle toward the thin and moving pericardium remains highly challenging and risky. To address this problem, we present a physics-driven sonification method for Extended Reality (XR)-based multisensory navigation to enhance user perception during the critical needle landing phase in PEA. Dynamic cardiac anatomy from 4D CTA was reconstructed and registered to a real-world coordinate system. Real-time needle tracking provided the position of the needle tip relative to moving cardiac structures and drove an audio-visual feedback module. The visual display presented navigational cues and dynamic anatomy, while the auditory display encoded physiological cardiac states using a multilayer physical membrane model. A phantom study was conducted with twelve cardiologists performing needle insertions under visual-only and multisensory feedback. The multisensory method significantly improved navigation safety ($χ^2 = 11.30$, $p < 0.01$), reducing myocardial contact (3.64% vs. 7.27%) and increasing correct access (90.91% vs. 52.73%). Needle placement accuracy improved, with closer membrane proximity (Cliff delta = 0.19) and reduced variability ($p < 0.05$). Execution time was comparable, while time-accuracy correlations differed significantly between modalities ($p < 0.01$). NASA-TLX indicated lower cognitive load with multisensory guidance ($p < 0.01$). These results demonstrate the feasibility of physics-driven sonification for improving spatiotemporal awareness and supporting user-centered surgical navigation.

翻译：经皮心外膜穿刺入路（PEA）在透视引导下于搏动心脏上实施，用于治疗心律失常。然而，将穿刺针推进至薄且运动的心包仍极具挑战性和风险。针对该问题，我们提出一种物理驱动声化方法，用于扩展现实（XR）多感觉导航，以增强PEA关键针尖着陆阶段的操作感知。重建了4D CTA动态心脏解剖结构，并将其配准至真实世界坐标系。实时针尖追踪提供了针尖相对于运动心脏结构的位置，并驱动视听反馈模块。视觉显示呈现导航线索与动态解剖结构，而听觉显示则通过多层物理膜模型编码生理性心脏状态。基于仿真模型开展实验，由十二名心脏病专家在仅视觉反馈与多感觉反馈条件下执行穿刺操作。多感觉方法显著提升导航安全性（χ² = 11.30，p < 0.01），将心肌接触率从7.27%降至3.64%，正确穿刺率从52.73%提升至90.91%。针尖定位精度改善，膜接近距离更小（Cliff delta = 0.19），变异性降低（p < 0.05）。执行时间无显著差异，但两种模态下时间-精度相关性存在显著差异（p < 0.01）。NASA-TLX量表显示多感觉引导可降低认知负荷（p < 0.01）。上述结果验证了物理驱动声化方法在提升时空感知及支持用户中心型手术导航中的可行性。