Interventions for valvular disease and heart failure

Virtual reality-assisted conscious sedation during transcatheter aortic valve implantation: a randomised pilot study

EuroIntervention 2020;16:e1014-e1020. DOI: 10.4244/EIJ-D-20-00269

Raphael Bruno
Raphael Romano Bruno1, MD; Yingfeng Lin1, MD; Georg Wolff1, MD; Amin Polzin1, MD; Verena Veulemans1, MD; Kathrin Klein1, MD; Ralf Westenfeld1, MD; Tobias Zeus1, MD; Malte Kelm1,2, MD; Christian Jung1, MD, PhD
1. Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany; 2. Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany

Aims: Virtual reality (VR) has been used successfully in different clinical settings to treat anxiety. This prospective, randomised pilot study aimed to investigate the feasibility and safety of VR in patients undergoing conscious sedation during transfemoral transcatheter aortic valve implantation (TAVI).

Methods and results: Thirty-two patients were included and randomised to VR intervention (n=16) or control (n=16). In the intervention group, patient-selected relaxing 3D videos were projected during the TAVI procedure; pain and anxiety before and after TAVI were measured using visual analogue scales (VAS; 0-10). The median age was 83 years (IQR 78.25-87). Patients’ baseline characteristics did not differ significantly between the groups. During TAVI under conscious sedation, the median duration of VR intervention was 30.5 minutes (IQR 23.5-46); 81.3% of the patients watched the videos until device implantation, 37.5% during the whole procedure. The VR intervention group reported significantly less anxiety after the procedure (VAS 2 [IQR 0-3.75] vs 5 [IQR 2-8], p=0.04) than patients randomised to control. In the intervention group, 93.8% would use VR during TAVI again. Nausea and vomiting did not occur more frequently compared to control.

Conclusions: VR interventions during TAVI to assist conscious sedation are safe and feasible, even in very old and frail patients. In this small cohort, there was a significant reduction in periprocedural anxiety.

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