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Pacing and Clinical Electrophysiology

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Induced trance helps anxiety in AF ablation

Visualising a ‘safe place’ reduces operative pain, according to research1 presented recently at EuroHeartCare 2014, held in Stavanger, Norway. Nurses guided patients into a trance and found it helped patients cope with pain and anxiety during ablation of atrial fibrillation (AF), it was reported.

In the first clinical study of visualisation during ablation of AF, the researchers compared outcomes between 76 patients who used visualisation and 71 patients who received conventional care. All patients were awake during the 2–4 hour treatment and received local anaesthesia plus painkillers when they signalled the nurse using a push button. During the procedure patients scored their pain and anxiety levels every 15 minutes and after specific painful experiences.

The researchers found that patients who used visualisation during the procedure were in pain less often and asked for fewer painkillers. When the patients perceived pain, there were no differences between groups in the perception of pain intensity and no differences in anxiety levels.

Clinical nurse specialist and lead author Marianne Wetendorff Nørgaard (Copenhagen University Hospital, Rigshospitalet, Denmark) said: “We ask patients to describe a comfortable safe place they want to be during the procedure. People have chosen a summer house, the beach, or the woods. During the procedure the nurse asks the patient to focus on their safe place and how it looks, smells and sounds.”

8800802_s-1She added: “When the patient expresses pain, the nurse helps the patient visualise an alternative scenario to the invasive procedure. For example, if the patient says ‘my chest is burning’, the nurse may say ‘imagine that it’s a cold day and there is ice on your chest’. Patients tell us that being in this trance like state with safe images makes the procedure a pleasant experience and it feels shorter.”

“Visualisation has the potential to reduce pain and anxiety in numerous procedures. Many patients could even avoid having general anaesthesia, which carries risks. Patients who used visualisation expressed pain fewer numbers of times and asked for less painkillers. Their perceived pain intensity may have been the same because we interrupted their visualisation at regular intervals to record pain and anxiety levels. If they had been allowed to stay in their trance like state during the entire procedure, their perceived pain intensity may have also reduced,” Mrs Nørgaard continued.

The current investigation explored in more detail the experiences of 14 patients who had used visualisation during the clinical study. Qualitative interviews were conducted and subjected to inductive content analysis.

Mrs Nørgaard said: “We know that patients want to be in control when they come into hospital and into the operating room. But patients who used visualisation during their invasive procedure said they felt it allowed them to let go of the control because they felt secure and had something else to focus on.”

“Some countries, for example the US and in southern Europe, use general anaesthesia during ablation of AF which can be risky during such a long procedure and is expensive. Some of these patients could use local anaesthesia and visualisation instead, plus painkillers as needed. Extra nurses are not needed in the operating room, you just need to train the ones who are already there,” she concluded.

Reference

1. Nørgaard MW, Werner A, Abrahamsen R, Larsen B, Darmer MR, Pedersen PU. Visualization and attentive behavior for pain reduction during radiofrequency ablation of atrial fibrillation. Pacing Clin Electrophysiol 2013;36:203–13. http://dx.doi.org/10.1111/pace.12032

Published on: April 30, 2014

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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