Impact of Virtual Reality on Anxiety and Pain During Implantation of Cardiac Implantable Electronic Devices (CIED)

Impact of Virtual Reality on Patients' Anxiety and Pain During Implantation of Cardiac Pacemakers, Implantable Cardioverter-defibrillators, or Cardiac Resynchronization Therapy: a Randomized Controlled Study

Purpose:

This study aimed to evaluate whether virtual reality technology positively affects patients' pain and anxiety throughout the entire procedure of implantation of cardiac pacemakers, defibrillators, or cardiac resynchronisation therapy.

Methods:

From January 2024 to Mai 2025, 111 Patients undergoing implantation of cardiac single-chamber or dual-chamber pacemakers or defibrillators and cardiac resynchronisation therapy were randomized to either a control group (n=55) or an intervention group (n=56). The control group received standard preoperative care using local anaesthesia and on-demand conscious sedation. A virtual reality headset was used in the intervention group in addition to the standard care intraoperatively. The State-Trait Anxiety Inventory-State (STAI-S) questionnaire was filled out by patients preoperative and immediate postoperative to best determine their perioperative state anxiety.

Inclusion criteria

• Age ≥ 18 years
• Indication for implantation of a cardiac pacemaker, ICD, or CRT device due to one of the following:
• Complete heart block (AV block III°)
• Symptomatic bradycardia due to sinus node dysfunction
• Tachy-brady syndrome
• Atrial fibrillation with slow ventricular rate
• Symptomatic bradycardia due to AV block II° type Mobitz
• Secondary prevention of sudden cardiac death due to ventricular tachycardia
• Primary prevention in patients with heart failure with reduced ejection fraction
• Primary prevention in patients with heart failure with reduced ejection fraction and complete left bundle branch block
• "Pace and ablate" strategy for therapy-resistant persistent atrial fibrillation
• Need to Upgrade to CRT-P due to a high percentage of right ventricular pacing

Exclusion Criteria:

• Significant language barrier preventing consent or cooperation
• severe panic disorder or claustrophobia