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