Influence of audiovisual distraction on the feeling of stress, analgesic sedation and patient satisfaction during electrophysiological examinations on the heart

Background

Distraction using audiovisual stimuli has mostly been researched in a pediatric population with the results showing an inhibiting effect on stress and anxiety as well as the subjective perception of pain. We designed a study to test if audiovisual distraction may reduce the level of sedatives and analgesics by reducing anxiety and stress during electrophysiological intervention (EP).

 

Methods

We conducted a clinical intervention pilot study that was carried out in a randomized controlled manner. All patients who were to receive an electrophysiological study (EP) with subsequent ablation therapy based on a diagnosed cardiac arrhythmia were included. A total of 70 patients were randomized 1:1 and assigned to either the control group (CTL group) or the intervention group (AVD group). In addition to the normal procedure and the standardized analgesic sedation, all patients in the AVD group received audiovisual glasses, which provided them with audiovisual distraction during the procedure. The feeling of fear and stress during the procedure was recorded using the surrogate parameter blood pressure. The patient satisfaction was assessed using the adapted German-language version of the Client Satisfaction Questionnaire, ZUF-8. Numeric scale (NRS) was used to quantify the perceived pain during the procedure.  The difference between the estimated duration of the procedure and the actual duration of the procedure was compared.

 

Results

The mean age in decades was comparable (p=0.45) for both CTL (5.4 ± 1.5 decades) and AVD group (5.8 ± 1.5). AVD group included significantly more male patients (73.5% vs. 44.4%, p=0.01). There was no difference in level of anxiety at the baseline before the begin of the procedure between the groups (Figure 1).

There was no significant difference between the mean blood pressure values of the CTL and AVD groups (135 vs. 141.24; p = 0.32; 74 .5 vs. 72.59; p = 0.447) (Figure 2A). The mean of the total score according to ZUF-8 questionnaire was comparable in both CTL and AVD group (26.5 vs. 26.8 points, p = 0.356). The average response for perceived pain using NRS scale was comparable between the groups was (2.94 vs 2.68 for CTL and AVD, respectively p = 0.816). The patients in AVD group reported a perceived duration of the procedure that was on average 79 minutes shorter, compared to CTL group where the procedure was perceived only 44 minutes shorter, without reaching the bounds of statistical significance (p = 0.692) (Figure 2B).  The patients in AVD group required on the average a lower dose of Midazolam (0.005 mg/kg/hour vs 0.007 mg/kg /hour for AVD and CTL respectively), without reaching statistically significant difference (p = 0.066).

Most patients in AVD group (22 of 34; 31.4%) could identify with the statement “The audiovisual glasses made me feel distracted at times.” The second most frequently chosen statement (7 out of 34; 10%) was: “The audiovisual glasses made me feel completely distracted and more relaxed.” 31 of 34 patients (91.2%) in the AVD group would recommend the use of audiovisual glasses to their friends during their procedure.

 

Conclusion

The use of audiovisual glasses has no influence on the patients’ feelings of anxiety and stress during EP. The use of audiovisual glasses can temporarily induce distraction during electrophysiological examinations, while they  do not seem to be sufficient in reducing pain intensity during ablation therapy.