Cardiology · Medical Literature
Intervention Study of Virtual Reality Technology on Sympathetic Nerves and Emotion in Patients with Acute Coronary Syndrome.
Abstract
This study aimed to investigate the effects of virtual reality (VR) technology on the sympathetic nervous system and the emotional status in patients with acute coronary syndrome (ACS). A total of 102 patients with ACS, who were treated in the department of cardiology at the Second Affiliated Hospital of Zhejiang Chinese Medical University from December 2022 to December 2024, were enrolled into the study. Then, they were randomly divided into a control group (n=50) and an intervention group (n=52) using a random number table. The control group received conventional treatment, while the intervention group underwent virtual reality (VR) therapy combined with conventional treatment. The differences in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), time-domain indices of heart rate variability (HRV), standard deviation of the normal respiratory rate (RR) intervals (SDNN), standard deviation of the average normal-to-normal (NN) [NS1.1] intervals in 5-minute segments of an entire recording (SDANN), root-mean-square of the successive differences of adjacent RR intervals (RMSSD), low frequency(LF)/high frequency (HF) ratio, LF, HF, three catecholamine indicators [norepinephrine (NE), epinephrine (E), dopamine (DA)], and psychological status assessed by Self-rating Anxiety Scale (SAS) and Hospital Anxiety and Depression Scale (HADS) were observed and calculated before and after treatment in both groups. The increases in ∆SDNN and ∆SDANN in the intervention group were significantly greater than those in the control group, and the decreases in ∆LF, ∆LF/ HF ratio, ∆NE, ∆SAS and ∆HADS in the intervention group were significantly greater than those in the control group (all P<0.05). VR technology can alleviate the hyperactivity of the sympathetic nervous system and improve anxiety in patients with ACS.
Clinical relevance
Sympathetic nervous system hyperactivity and anxiety are prevalent yet undertreated comorbidities in acute coronary syndrome (ACS) that adversely affect autonomic tone, arrhythmia risk, and cardiovascular outcomes. This RCT addresses the clinical gap of non-pharmacological adjunctive interventions for autonomic dysregulation and psychological distress in the ACS inpatient population. Given the growing burden of psychocardiology and limited uptake of traditional cardiac rehabilitation, evidence supporting immersive VR therapy as a bedside-deliverable adjunct is timely and clinically actionable.
Key findings
1. In a randomized controlled trial of 102 ACS patients (control n=50; VR intervention n=52), adjunctive VR therapy produced significantly greater increases in ΔSDNN and ΔSDANN compared to conventional treatment alone (both P<0.05), indicating improved overall heart rate variability and parasympathetic modulation. 2. The VR intervention group demonstrated significantly greater reductions in ΔLF power compared to controls (P<0.05), reflecting attenuation of sympathetic nervous system hyperactivity as measured by spectral HRV analysis. 3. The LF/HF ratio — a validated index of sympathovagal balance — decreased significantly more in the intervention group than in the control group (P<0.05), confirming a favorable shift away from sympathetic dominance. 4. Plasma norepinephrine (NE) levels showed significantly greater reductions (ΔNE) in the VR group versus controls (P<0.05), providing biochemical corroboration of sympatholytic effect; notably, no significant between-group differences were reported for epinephrine (E) or dopamine (DA). 5. Self-rating Anxiety Scale (SAS) scores decreased significantly more in the VR intervention group (ΔSAS, P<0.05), demonstrating a measurable anxiolytic benefit of VR therapy. 6. Hospital Anxiety and Depression Scale (HADS) scores were also significantly more reduced in the intervention group (ΔHADS, P<0.05), supporting broader psychological benefit beyond anxiety alone. Note: Precise effect sizes, confidence intervals, and NNT/NNH were not reported in the available abstract.
Practice implications
VR therapy should be considered as a bedside-deliverable, non-pharmacological adjunct to standard ACS care for patients exhibiting signs of autonomic dysregulation or clinically significant anxiety, particularly in settings where early cardiac rehabilitation or psychologist consultation is limited. Clinicians should monitor HRV indices (SDNN, LF/HF ratio) and catecholamine levels as objective biomarkers to quantify sympathetic modulation when evaluating response to VR or other autonomic-targeting interventions in ACS. Integration of validated psychological screening tools such as the SAS and HADS into routine ACS admission workflows is warranted to identify candidates most likely to benefit from adjunctive psychocardiology interventions including VR therapy.