Pre-procedural virtual reality education reduces anxiety in patients undergoing atrial septal closure - Results from a randomized trial.

Background: Patients undergoing invasive cardiothoracic procedures are prone for pre-procedural anxiety and depression. Patient education is known to reduce anxiety. This study was performed to assess the effect of Virtual Reality (VR) as a means to educate patients to reduce pre-procedural anxiety in adult patients undergoing percutaneous closure of a patent foramen ovale (PFO) or atrial septal defect (ASD). Methods and results: We randomly assigned 60 patients (48% male; age 44 ​± ​11 years) with an indication for percutaneous PFO or ASD closure to receive pre-procedural education by their cardiologist (control) or to receive additional education through a VR information film depicting the day of the procedure (intervention). The primary outcome was change in the pre-procedural anxiety as assessed using the State Trait Anxiety Inventory (STAI) and the Amsterdam Pre-operative Anxiety and Information Scale (APAIS) questionnaires, filled-in during the outpatient clinic visit (baseline) and one week prior to the procedure (follow-up). At baseline patients in both groups experienced equal levels of anxiety (STAI state anxiety: control 40 ​± ​10 vs. intervention 39 ​± ​9; p ​= ​0.70). During follow-up, anxiety increased in the control group, but remained unchanged in the intervention group (45 ​± ​11 vs. 38 ​± ​7, p ​= ​0.02). No differences were found for the APAIS anxiety scale. Conclusion: Patient education using Virtual Reality is effective in reducing pre-procedural anxiety in patients undergoing percutaneous PFO or ASD closure. General introduction of VR for a large population of patients undergoing invasive cardiac procedures should be considered to reduce anxiety in this already fragile population.