Optimizing conscious sedation and anxiety control using virtual reality in the electrophysiology lab: a retrospective pilot study on VT ablation
R Y Yilancioglu, O E Turan, U D Inevi, M Ozcan, E E OzcanAbstract
Background
Ventricular Tachycardia (VT) ablation is associated with significant sedation requirements. During VT, conscious sedation with deep anesthesia may affect anxiety and hemodynamic parameters, which may impact the tolerability of ventricular tachycardia mapping.
Aim
We aimed to evaluate the impact of using virtual reality (VR)glasses as an additional distraction tool on the amount of anesthetic required, as well as on anxiety features, hemodynamics and the outcomes of the procedure during VT ablation.
Method
This single-center, retrospective cohort study included 36 consecutive patients undergoing de novo endocardial ablation for hemodynamically stable sustained monomorphic VT (n=15 VR Group, n=21 Control Group). All procedures were performed under conscious sedation (midazolam and fentanyl). Patients who received adjunctive VR during their procedure (VR Group) were compared to contemporary controls receiving standard conscious sedation (Control Group). Patients undergoing epicardial VT ablation or those with hemodynamically unstable VTs were excluded.
Results
Baseline characteristics, including age (64.5 ± 9.8 vs. 66.1 ± 10.2, p=0.68) and LVEF (33 ± 7% vs. 32 ± 8%, p=0.74), were comparable between the groups. The VR group required significantly lower mean doses of midazolam (2.9 ± 1.2 mg vs. 4.7 ± 1.5 mg; p < 0.001) and fentanyl (138 ± 35 mcg vs. 215 ± 60 mcg; p < 0.001). Furthermore, the VR group experienced a significantly greater reduction in peri-procedural anxiety (Δ STAI-S score: -10.2 ± 4.1 vs. -2.5 ± 5.0; p = 0.005). No significant differences were observed in total procedure time or hemodynamic changes during VT.
Conclusion
In this propensity-matched retrospective analysis, the use of adjunctive VR during VT ablation was associated with a significant reduction in sedative and analgesic requirements. These findings suggest VR is a potent non-pharmacological tool for optimizing sedation in the EP lab, warranting further validation in prospective randomized trials.