Virtual Reality Distraction for Reducing Pain and Anxiety During Percutaneous Cardiovascular Interventions: A Systematic Review and Meta-Analysis with Trial Sequential Analysis.

Background and

Objectives

Percutaneous cardiovascular interventions (PCIs) have become a cornerstone in the management of cardiovascular diseases. However, patients often experience significant anxiety and pain during these procedures, which can negatively impact their overall experience and clinical outcomes. Virtual reality (VR) is an emerging non-pharmacological intervention designed to alleviate procedural anxiety and pain through immersive distraction techniques. Materials and

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) identified from PubMed, CENTRAL, Scopus, Google Scholar, and Web of Science up to November 2024. Primary outcomes were peri-procedural anxiety and pain; secondary outcomes included vital signs, procedure duration, and safety (e.g., delirium). Continuous data were pooled using a random-effect model and reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs) in Stata MP v.17. Certainty of evidence was assessed using the GRADE approach.

Results

Ten RCTs involving 890 patients were included. VR distraction significantly reduced peri-procedural anxiety (SMD: -0.70; 95% CI: -1.15 to -0.26; p < 0.001). However, no significant differences were observed between groups for peri-procedural pain (SMD: -0.64; 95% CI: -1.45 to 0.16; p = 0.12), systolic blood pressure (SMD: -0.31; 95% CI: -1.23 to 0.61; p = 0.50), diastolic blood pressure (SMD: -0.25; 95% CI: -1.07 to 0.56; p = 0.54), heart rate (SMD: -0.44; 95% CI: -0.93 to 0.05; p = 0.08), respiratory rate (SMD: -0.93; 95% CI: -2.18 to 0.31; p = 0.14), or procedure duration (SMD: 0.07; 95% CI: -1.14 to 0.28; p = 0.49).

Conclusions

VR significantly ameliorated peri-procedure anxiety in patients undergoing PCIs; however, it had no effect on peri-procedure pain or vital signs. This is based on uncertain evidence from heterogeneous studies, warranting further confirmation through large-scale RCTs.