Introduction:
Balloon-in-basket pulsed field ablation (BiB-PFA) enables atrial fibrillation (AF) ablation under conscious sedation (CS). While augmented reality (AR) has been proposed to improve patient comfort during invasive procedures, its benefit in an already well-tolerated awake ablation setting remains uncertain.
Objective:
To evaluate the impact of adjunctive AR glasses on sedation requirements and patient comfort during BiB-PFA performed under CS.
Methods:
In this prospective, single-center study, 50 patients undergoing AF ablation with BiB-PFA were treated under a standardized CS protocol. Patients were allocated to either ablation without AR (n=25) or ablation with adjunctive AR glasses (n=25). Sedation requirements and patient-reported outcomes were assessed during ablation, as well as at 1-hour and 1-day post-procedure.
Results:
Baseline characteristics were comparable. All procedures were completed without conversion to deep sedation. Fentanyl requirements were lower in the AR group (1.1 vs. 1.4 µg/kg in the control group; p=0.015), while other sedatives were similar. Intraprocedural pain was moderate and comparable between groups (AR: 5.0 [4.0–7.0] vs. control: 7.0 [4.0–8.0]; p=0.336), with lower retrospective pain ratings at 1 hour (AR: 3.0 [0.0–7.0] vs. control: 2.0 [0.0–5.0]; p=0.976) and 1 day post-procedure (AR: 3.0 [0.0–5.0] vs. control: 2.0 [0.0–4.3]; p=0.762) with significant reduction over time (p<0.001). Dyspnea and procedural anxiety remained low and comparable between groups. Patients in the AR group reported a higher perceived calming effect of the procedural environment (AR: 10.0 [8.0–10.0] vs. control: 8.5 [6.0–9.3]; p=0.015). Satisfaction was high in both groups. Recommendation scores were high overall, with higher values in the control group (control: 90 [90–100] vs. AR: 90 [70–90]; p=0.023). Retrospective anxiety at day 1 remained low but was higher in the AR group (AR: 2.0 [0.0–5.0] vs. control: 0.0 [0.0–0.0]; p=0.002).
Conclusion:
CS for BiB-PFA is feasible and well tolerated. Intraprocedural pain was low, while satisfaction and recommendation were high in both groups, with slightly higher values without AR support. AR use was associated with modest reduced opioid requirements, suggesting a potential role in selected patients. Slightly higher retrospectively reported anxiety at 1 day in AR-group, while overall low, warrants further investigation.
