{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:23:43Z","timestamp":1793075023689,"version":"4.5.0"},"reference-count":51,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>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: \u20130.70; 95% CI: \u20131.15 to \u20130.26; p &lt; 0.001). However, no significant differences were observed between groups for peri-procedural pain (SMD: \u20130.64; 95% CI: \u20131.45 to 0.16; p = 0.12), systolic blood pressure (SMD: \u20130.31; 95% CI: \u20131.23 to 0.61; p = 0.50), diastolic blood pressure (SMD: \u20130.25; 95% CI: \u20131.07 to 0.56; p = 0.54), heart rate (SMD: \u20130.44; 95% CI: \u20130.93 to 0.05; p = 0.08), respiratory rate (SMD: \u20130.93; 95% CI: \u20132.18 to 0.31; p = 0.14), or procedure duration (SMD: 0.07; 95% CI: \u20131.14 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.<\/jats:p>","DOI":"10.3390\/medicina61060957","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T10:24:45Z","timestamp":1747909485000},"page":"957","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Virtual Reality Distraction for Reducing Pain and Anxiety During Percutaneous Cardiovascular Interventions: A Systematic Review and Meta-Analysis with Trial Sequential Analysis"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1244-7769","authenticated-orcid":false,"given":"Ebraheem","family":"Albazee","sequence":"first","affiliation":[{"name":"Otorhinolaryngology-Head and Neck Surgery, Kuwait Institute for Medical Specializations (KIMS), Kuwait City 13018, Kuwait"},{"name":"Department of Otolaryngology-Head and Neck Surgery, Al-Jahra Hospital, Al Jahra 03200, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7387-6189","authenticated-orcid":false,"given":"Abdullhadi","family":"Alrajehi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1748-5913","authenticated-orcid":false,"given":"Fahad M.","family":"Alsahli","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8857-9031","authenticated-orcid":false,"given":"Abdillatef","family":"Alqemlas","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0501-6428","authenticated-orcid":false,"given":"Ahmad","family":"Aldhaen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2174-388X","authenticated-orcid":false,"given":"Abdullah","family":"Alkandari","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8957-7595","authenticated-orcid":false,"given":"Hamad","family":"Alkandari","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9320-1033","authenticated-orcid":false,"given":"Waleed","family":"Alkanderi","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specializations (KIMS), Kuwait City 13018, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100814","DOI":"10.1016\/j.jacadv.2023.100814","article-title":"Virtual Reality for Pain and Anxiety Management in Cardiac Surgery and Interventional Cardiology","volume":"3","author":"Hoekman","year":"2024","journal-title":"JACC Adv."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s43045-019-0004-9","article-title":"Psychiatric disturbances in patients undergoing open-heart surgery","volume":"26","author":"Younes","year":"2019","journal-title":"Middle East Curr. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1891\/1541-6577.30.1.70","article-title":"Educational video intervention effects on periprocedural anxiety levels among cardiac catheterization patients: A randomized clinical trial","volume":"30","author":"Ayasrah","year":"2016","journal-title":"Res. Theory Nurs. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1016\/j.ijcard.2016.11.043","article-title":"Anxiety levels of patients undergoing coronary procedures in the catheterization laboratory","volume":"228","author":"Delewi","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E213","DOI":"10.1503\/cmaj.131012","article-title":"Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: A 2-year prospective multicentre study","volume":"186","author":"Victor","year":"2014","journal-title":"CMAJ Can. Med. Assoc. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1097\/j.pain.0000000000000997","article-title":"Persistent postoperative pain after cardiac surgery: A systematic review with meta-analysis regarding incidence and pain intensity","volume":"158","author":"Reis","year":"2017","journal-title":"Pain"},{"key":"ref_7","first-page":"1","article-title":"Massage therapy reduces pain and anxiety after cardiac surgery: A systematic review and meta-analysis of randomized clinical trials","volume":"23\u201324","author":"Miozzo","year":"2016","journal-title":"Clin. Trials Regul. Sci. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Saab, O., Al-Obaidi, H., Merza, N., Bhagat, U., Al-Sagban, A., Algodi, M., Abuelazm, M., and El-Serag, H. (2024). The Impact of Visual Distraction Interventions on Patients\u2019 Pain and Anxiety During Colonoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Clin. Gastroenterol.","DOI":"10.1097\/MCG.0000000000002086"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"615","DOI":"10.2147\/VHRM.S2471","article-title":"Perioperative hypertension management","volume":"4","author":"Varon","year":"2008","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_10","first-page":"7","article-title":"Strategies for managing perioperative hypertension","volume":"23","author":"Goldberg","year":"2007","journal-title":"Crit. Care Clin."},{"key":"ref_11","first-page":"159","article-title":"Effect of virtual reality on preoperative anxiety in patients undergoing septorhinoplasty","volume":"73","author":"Baytar","year":"2023","journal-title":"Braz. J. Anesthesiol. (Engl. Ed.)"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Hughes, O., MacQuhae, F., Rakosi, A., Herskovitz, I., and Kirsner, R.S. (2016). Stress and wound healing. Stress and Skin Disorders, Springer.","DOI":"10.1007\/978-3-319-46352-0_19"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/S0022-3999(01)00258-6","article-title":"Anxiety and surgical recovery","volume":"51","author":"Stevenson","year":"2001","journal-title":"J. Psychosom. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/s00520-014-2358-1","article-title":"Side effects of analgesia may significantly reduce quality of life in symptomatic multiple myeloma: A cross-sectional prevalence study","volume":"23","author":"Sloot","year":"2015","journal-title":"Support. Care Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1002\/clc.23906","article-title":"The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta-analysis of randomized controlled trials","volume":"45","author":"Abdelazeem","year":"2022","journal-title":"Clin. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jcin.2012.11.005","article-title":"Moderate procedural sedation and opioid analgesia during transradial coronary interventions to prevent spasm: A prospective randomized study","volume":"6","author":"Deftereos","year":"2013","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1097\/ALN.0000000000002043","article-title":"Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology","volume":"128","author":"Apfelbaum","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s10916-024-02039-1","article-title":"Virtual Reality for the Management of Pain and Anxiety in Patients Undergoing Implantation of Pacemaker or Implantable Cardioverter Defibrillator: A Randomized Study","volume":"48","author":"Squara","year":"2024","journal-title":"J. Med. Syst."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1097\/AJP.0000000000000599","article-title":"Virtual Reality as a Distraction Intervention to Relieve Pain and Distress during Medical Procedures","volume":"34","author":"Indovina","year":"2018","journal-title":"Clin. J. Pain"},{"key":"ref_20","first-page":"2","article-title":"Comparing the Effect of Virtual Reality and Rhythmic Breathing on the Anxiety of the Patients Undergoing Coronary Angiography","volume":"27","author":"Pouryousef","year":"2021","journal-title":"Q. Horiz. Med. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e177","DOI":"10.1016\/j.pmn.2023.11.009","article-title":"Effects of Virtual Reality on Pain, Anxiety, Patient Satisfaction in Coronary Angiography: A Randomized Trial","volume":"25","author":"Turan","year":"2024","journal-title":"Pain Manag. Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"131130","DOI":"10.1016\/j.ijcard.2023.131130","article-title":"Virtual reality-assisted distraction during transcatheter aortic valve implantation under local anaesthesia: A randomised study","volume":"387","author":"Lind","year":"2023","journal-title":"Int. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.amjcard.2023.07.130","article-title":"Assessment of the Objective Effect of Virtual Reality for Preoperative Anxiety in Interventional Cardiology","volume":"205","author":"Larsson","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1053\/j.jvca.2023.11.041","article-title":"The Influence of Audiovisual Distraction on Pain Reduction During Transcatheter Aortic Valve Implantation Under Monitored Anesthesia Care: A Prospective Randomized Trial","volume":"38","author":"Pitts","year":"2024","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/s43044-021-00224-y","article-title":"The effect of virtual reality distraction on reducing patients\u2019 anxiety before coronary angiography: A randomized clinical trial study","volume":"73","author":"Keshvari","year":"2021","journal-title":"Egypt. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e1014","DOI":"10.4244\/EIJ-D-20-00269","article-title":"Virtual reality-assisted conscious sedation during transcatheter aortic valve implantation: A randomised pilot study","volume":"16","author":"Bruno","year":"2020","journal-title":"EuroIntervention"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e2151","DOI":"10.1002\/hsr2.2151","article-title":"Efficacy of virtual reality therapy versus pharmacological sedation for reducing pain and anxiety during coronary catheterisation procedures: A prospective randomised controlled trial","volume":"7","author":"Verain","year":"2024","journal-title":"Health Sci. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e13176","DOI":"10.1111\/ijn.13176","article-title":"Effects of virtual reality and acupressure interventions on pain, anxiety, vital signs and comfort in catheter extraction processes for patients undergoing coronary angiography: A randomized controlled trial","volume":"29","author":"Arslan","year":"2023","journal-title":"Int. J. Nurs. Pract."},{"key":"ref_29","first-page":"n71","article-title":"The The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_30","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V. (2023). Cochrane Handbook for Systematic Reviews of Interventions, Wiley-Blackwell."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1136\/bmj.39490.551019.BE","article-title":"Rating Quality of Evidence and Strength of Recommendations: What is \u201cquality of evidence\u201d and why is it important to clinicians?","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ  Br. Med. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"Rating Quality of Evidence and Strength of Recommendations: GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ Br. Med. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/biom.12817","article-title":"Quantifying publication bias in meta-analysis","volume":"74","author":"Lin","year":"2018","journal-title":"Biometrics"},{"key":"ref_36","unstructured":"(2024, December 17). TSA\u2013ctu.dk. Available online: http:\/\/ctu.dk\/tsa\/."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.hrtlng.2010.05.054","article-title":"Anxiety in patients undergoing percutaneous coronary interventions","volume":"40","author":"Trotter","year":"2011","journal-title":"Heart Lung J. Acute Crit. Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"103190","DOI":"10.1016\/j.amsu.2021.103190","article-title":"Effect of preoperative anxiety on postoperative pain on patients undergoing elective surgery: Prospective cohort study","volume":"73","author":"Tadesse","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"101201","DOI":"10.1016\/j.cpcardiol.2022.101201","article-title":"Improving Wellbeing After Acute Coronary Syndrome","volume":"48","author":"Liblik","year":"2023","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1016\/j.socscimed.2007.04.010","article-title":"Fears and beliefs of patients regarding cardiac catheterization","volume":"65","author":"Caldwell","year":"2007","journal-title":"Soc. Sci. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e17980","DOI":"10.2196\/17980","article-title":"The Effectiveness of Virtual Reality in Managing Acute Pain and Anxiety for Medical Inpatients: Systematic Review","volume":"22","author":"Smith","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e16106","DOI":"10.2196\/16106","article-title":"Understanding how virtual reality can support mindfulness practice: Mixed methods study","volume":"22","author":"Seabrook","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s12160-010-9248-7","article-title":"Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures","volume":"41","author":"Hoffman","year":"2011","journal-title":"Ann. Behav. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e001570","DOI":"10.1136\/bmjopen-2012-001570","article-title":"A systematic review of evidence on the links between patient experience and clinical safety and effectiveness","volume":"3","author":"Doyle","year":"2013","journal-title":"BMJ Open"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Caes, L., Orchard, A., and Christie, D. (2017). Connecting the mind\u2013body split: Understanding the relationship between symptoms and emotional well-being in chronic pain and functional gastrointestinal disorders. Healthcare, 5.","DOI":"10.3390\/healthcare5040093"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1038\/nrn3516","article-title":"Cognitive and emotional control of pain and its disruption in chronic pain","volume":"14","author":"Bushnell","year":"2013","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"26","DOI":"10.4037\/ccn2008.28.5.26","article-title":"Management of patients after percutaneous coronary interventions","volume":"28","year":"2008","journal-title":"Crit. Care Nurse"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.pmn.2022.03.004","article-title":"The Effect of Virtual Reality Distraction Intervention on Pain, Anxiety, and Vital Signs of Oncology Patients Undergoing Port Catheter Implantation: A Randomized Controlled Study","volume":"23","author":"Menekli","year":"2022","journal-title":"Pain Manag. Nurs."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"3557","DOI":"10.1111\/ejn.14499","article-title":"Vection in virtual reality modulates vestibular-evoked myogenic potentials","volume":"50","author":"Gallagher","year":"2019","journal-title":"Eur. J. Neurosci."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Weech, S., Kenny, S., and Barnett-Cowan, M. (2019). Presence and cybersickness in virtual reality are negatively related: A review. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.00158"},{"key":"ref_51","first-page":"1439","article-title":"Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide","volume":"20","author":"Juexuan","year":"2020","journal-title":"Chin. J. Evid. Based Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/6\/957\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:38:40Z","timestamp":1760031520000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/6\/957"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":51,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["medicina61060957"],"URL":"https:\/\/doi.org\/10.3390\/medicina61060957","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,22]]}}}