Abstract 4141033: Acute clinical outcomes following virtual reality implementation in the electrophysiology laboratory

Introduction: Pain discomfort increases procedural time in electrophysiology laboratory and prolongs surgical length. Virtual reality-based analgesia (VR-A) improves patient’s acceptance of the procedural steps, mostly in the emergency context. To date, routine adoption of VR-A is limited in cardiology since it is recommended for other surgeries. Hypothesis: we postulated that administration of VR-A would facilitate patient’s compliance, allowing to increasing number of electrophysiology procedures, to reducing burden of complications, and to accelerating discharge. Methods: from April 2024 to May 2024 patients admitted to our academic hospital for cardiac rhythm disorders requiring pacemaker (PM) or implantable cardioverter/defibrillator (ICD) were enrolled. They were randomized in two groups (allocation ratio 1:1) by including either standard sedation protocol, or VR-A for cardiac device implants. Numeric rating scale score was used to assess pain. Variation of vital parameters was measured at baseline, 15, 30 and 60 min after procedural start, as well as at 30 min after procedural ending for an objective evaluation of pain. Statistical analysis was performed with SPSS. Results: Baseline clinical characteristics did not differ between groups. Patients underwent PM (N=12) and ICD (N=8) implantations, showing similar allocation and mean procedural durations (69.5±23.4 min vs 69.5±10.9 min, p =0.3), but significant difference in numeric rating scale score (4.5±0.8 vs.5.9±1.7, p =0.02) in VR-A vs standard group. Standard protocol registered significant differences in blood pressure [F(4, 45)=6.95; p <0.001] and in heart rate [F(4, 45)=12.55; p <0.001] during interventions, with greater variation between the baseline and 60-min determinations at post-hoc analysis ( p <0.001). No significant differences were found in VR-A group for blood pressure [F(4, 45)=1.61; p =0.19] and heart rate [F(4, 45)=0.47; p =0.78]. Leadless PM (2/12, 17%) and subcutaneous ICD (2/8, 25%) while less invasive and well tolerated procedures allowed discharge during the same day of the intervention, by simply combining VR-A and remote patient monitoring provided at that time. Conclusions: VR-A has shown to be an effective tool for pain management during electrophysiology procedures. Participants immersed in VR-A experienced lower pain, less distressed and unpleasant feelings, without psychological impairment, until declaring to prefer VR-A for potential future medical procedures.