Abstract

Aims: Pre-procedural anxiety can negatively impact outcomes in patients undergoing percutaneous cardiac interventions, but its role in Transcatheter Edge-To-Edge Repair (TEER) is unclear. This study evaluates whether Virtual Reality (VR)-based patient education reduces anxiety in adults scheduled for TEER.
Methods: In this single-center randomized controlled trial, 76 patients referred for mitral or tricuspid TEER at Amsterdam UMC were randomized 1:1 to receive either standard verbal education (control) or standard education plus a 7.5-minute immersive VR experience. Anxiety was measured using the State- Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Scale (HADS) immediately after education and within one week prior to the procedure.
Results: Baseline analyses included 70 patients (mean age 77.9±7.3 years, 60% male); 50 completed follow-up. Immediately after education, mean state anxiety scores were significantly lower in the VR group compared to controls (37.7 vs. 41.9; p=0.04). However, state anxiety increased over time in the VR group (+3.7 points; p=0.023), while the control group showed no significant change. At follow-up, anxiety scores were similar between groups. Trait anxiety and HADS-A scores remained stable.
Conclusion: VR-based education acutely reduces state anxiety before TEER, but the effect is transient. Optimal timing of VR interventions is essential to maximize benefit.

Keywords: Virtual reality; MitraClip; Triclip; Mitral valve regurgitation; Tricuspid valve regurgitation; Patient education

Abbreviations: EFS: Edmonton Frail Scale; HADS: Hospital Anxiety and Depression Scale; M-TEER: Mitral Transcatheter Edge-To-Edge Repair; NYHA: New York Heart Association; S-STAI: State Anxiety; STAI: State-Trait Anxiety; T-TEER: Tricuspid Transcatheter Edge-To-Edge Repair; T-STAI: Trait Anxiety; TEER: Transcatheter Edge-To-Edge Repair; VR: Virtual Reality