Understanding how patients use visualization during ablation of atrial fibrillation in reducing their experience of pain, anxiety, consumption of pain medication and procedure length: Integrating quantitative and qualitative results

Appl Nurs Res. 2018 Feb:39:229-240. doi: 10.1016/j.apnr.2017.11.026. Epub 2017 Nov 22.


Background: Patients who undergo radiofrequency ablation of atrial fibrillation with a light conscious sedation often feel pain during the procedure which can be difficult to relieve with pharmacological pain treatment alone. In a quasi-experimental study, it was found that visualization together with usual pain medication reduced the amount of analgesics used. In addition, patients spontaneously expressed pain significantly fewer times outside the scheduled measurements. No difference was found in the perception of pain intensity or anxiety and procedure length in the study. In a subsequent qualitative study with patients from the intervention group in the quantitative study, patients reported visualization as a positive experience which helped them manage pain and anxiety by supporting their individual strategies and without inconvenience.

Aim: To examine patients' experiences with the effect of visualization during ablation of atrial fibrillation and its association with pain intensity, anxiety, pain medication and procedure length.

Methods: A mixed-method study with explanatory sequential design including a quasi-experimental study with a control and an intervention group and a qualitative interview study with semi-structured interviews. The results from the two studies in the mixed method study have been integrated by merging and constructing follow-up joint displays.

Results: Three themes were identified from the integration of the results from the quantitative and qualitative studies when analyzing and interpreting the results: "Zero pain is not always the goal"; "Not a real procedure time reduction but a sense of time shrinkage" and "Importance of the nurse's presence, visualization or not".

Conclusion: Visualization can help patients to manage procedural pain when going through ablation of atrial fibrillation but the effect of an intervention such as visualization cannot be measured by pain intensity because the effect of visualization helps patients to cope with the pain and not to reduce the experience of pain intensity. It was shown that the patients had a feeling of reduced procedure time, although it was not reduced statistically significantly by using visualization. Finally, patients did not feel high anxiety during the procedure which was in line with very low values of anxiety measured in the quantitative study but at the same time the presence of the staff was of great importance to them in providing a feeling of security. A reduction of analgesics as found in the study is not only a matter of safety, it is also important in the patient's perception.

Keywords: Ablation of atrial fibrillation; Hypnosis; Mixed methods research; Pain; Procedural pain; Visualization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Analgesics / therapeutic use*
  • Anxiety / psychology*
  • Anxiety / therapy*
  • Atrial Fibrillation / surgery*
  • Behavior Therapy / methods
  • Catheter Ablation / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain / drug therapy*
  • Pain / psychology*
  • Pain Management / methods


  • Analgesics