Background:
Catheter ablation has emerged as an important heart rhythm control strategy that is used increasingly in an earlier stage of the atrial fibrillation (AF) disease process. However, catheter ablation is an invasive approach and is accompanied by pre-, and periprocedural anxiety and stress in AF patients. Adequate patient preparation and information provision is essential and might improve patient related outcomes. Virtual reality (VR) might offer a new possibility for patient information provision.

Aim:
We evaluate the effectiveness of a lifelike 360° VR preprocedural education video in information provision and patient related outcomes including procedure-related knowledge, satisfaction with the information obtained and anxiety in patients around the AF catheter ablation.      Methods. Consecutive patients who were scheduled for AF catheter ablation were assigned to the control group or to the VR group (intervention group). The control group received standard preprocedural information through oral counselling and information leaflets. The VR group received the standard information as well as a short 360˚ VR video via in-hospital VR headset and a disposable cardboard VR viewer for home use. Patients were asked to complete the Amsterdam Preoperative Anxiety and Information Scale (APAIS) together with some additional questions regarding procedural experience and satisfaction based on procedure-based information provision both pre- and post-ablation.

Results:
 A total of 134 patients (38% female, age 66 [58-72] years) were included. Patients in the VR group indicated less concerns about the catheter ablation procedure than controls (50% [23-60%] vs 60% [40-70%], P=0.031) and reported to be better informed about the catheterization laboratory environment (85% [60-100%] vs 70% [50-90%], P=0.043). In the VR subgroup, females were more worried about the ablation procedure as compared to males (60% [50-70%] vs 50% [10-60%], P=0.004). Thirty-two patients in the VR group (49%) used the disposable cardboard VR viewer at home. In 22 patients (69%), home use of the video resulted in discussion with relatives. Fourteen patients (44%) thought the in-hospital VR headset was of no added value compared to the disposable cardboard VR viewer. Of the 134 included patients, 101 patients (75%) completed a post-ablation questionnaire. Patients in the VR group tended to be more satisfied with the preprocedural information provision after the procedure has been performed as compared to patients in the control group (90% [73-100%] vs 80% [70-90%], P=0.056).

Conclusion:
In patients scheduled for AF catheter ablation, a lifelike 360° VR preprocedural educational video led to better information provision with higher patient satisfaction and higher procedure-related knowledge. VR lets patients virtually experience the hospital environment and offers the possibility to review and discuss this with family or relatives at home.