Virtual Reality for Sedation During Atrial Fibrillation Ablation in Clinical Practice: Observational Study

Abstract

Background Connected devices are dramatically changing many aspects in health care. One such device, the virtual reality (VR) headset, has recently been shown to improve analgesia in a small sample of patients undergoing transcatheter aortic valve implantation. Objective We aimed to investigate the feasibility and effectiveness of VR in patients undergoing atrial fibrillation (AF) ablation under conscious sedation. Methods All patients who underwent an AF ablation with VR from March to May 2020 were included. Patients were compared to a consecutive cohort of patients who underwent AF ablation in the 3 months prior to the study. Primary efficacy was assessed by using a visual analog scale, summarizing the overall pain experienced during the ablation. Results The AF cryoablation procedure with VR was performed for 48 patients (mean age 63.0, SD 10.9 years; n=16, 33.3% females). No patient refused to use the device, although 14.6% (n=7) terminated the VR session prematurely. Preparation of the VR headset took on average 78 (SD 13) seconds. Compared to the control group, the mean perceived pain, assessed with the visual analog scale, was lower in the VR group (3.5 [SD 1.5] vs 4.3 [SD 1.6]; P=.004), and comfort was higher in the VR group (7.5 [SD 1.6] vs 6.8 [SD 1.7]; P=.03). On the other hand, morphine consumption was not different between the groups. Lastly, complications, as well as procedure and fluoroscopy duration, were not different between the two groups. Conclusions We found that VR was associated with a reduction in the perception of pain in patients undergoing AF ablation under conscious sedation. Our findings demonstrate that VR can be easily incorporated into the standard ablation workflow.

Virtual Reality Hypnosis in the Electrophysiology Lab: When Human Treatments Are Better than Virtual Ones

“…However, the level of pain reported was low in both groups, as were the doses of medications. The VAS pain perception scores are in contradiction with those of Roxburgh et al, who found a significant difference between groups [9]: indeed, our absolute result for VAS score in the VRH group is quite close to Roxburgh et al's (3.74 in our study and 3.5 in their study, respectively), but the results in the two control groups are different (3.07 vs. 4.3, respectively).…”

“…Roxburgh et al recently published a similar study in a population undergoing the AF cryoablation [9], but our results are opposite of theirs, particularly in terms of procedural comfort. Their study recruited 48 patients, the duration of procedures was not reported, and the main endpoint was assessed 45 min after the end of the procedure in patients receiving narcotics, which could be a bias (for example memory bias).…”

“…Electrophysiological (EP) procedures and cardiac electronic device implantation can generate the same mindset in patients and are mostly performed under conscious sedation. One study on VRH in the cryoablation of atrial fibrillation (AF) has recently been published [9], but to the best of our knowledge, VRH has never been investigated for all types of routine procedures in the electrophysiology laboratory (EP lab).…”

Sedation/analgesia techniques for nonoperating room anesthesia: new drugs and devices

“…A recent pilot study of virtual reality glasses in colonoscopy patients [36] revealed that the virtual reality experience provided a pleasant distraction and did not compromise the procedure. A prospective cohort study in patients presenting for ablation for atrial fibrillation in the cardiology suite compared a virtual reality headset with a historical control [37 ▪ ]. Patients in the virtual reality group reported less pain and felt more comfortable.…”

A prospective, double-blind, pilot, randomized, controlled trial of an “embodied” virtual reality intervention for adults with low back pain

“…34,63 Virtual reality can enable existing treatments to be offered at scale through automation, but it can also improve the content and impact of both assessment and intervention. Although there are many reports of VR for analgesia 30,49,56 and sedation, 54 there are few examples of attempted use in chronic pain. 34 Notable exceptions include randomized controlled trials of skills-based interventions with a focus on emotional self-regulation 4,12,24,25 and rehabilitation interventions with a focus on education and increasing movement.…”