Abstract Background Cardiac Magnetic Resonance Imaging (CMR) is crucial for diagnosing and stratifying cardiac disease, but up to 10% of patients face challenges due to claustrophobia. Conventional methods for overcoming claustrophobia have limited success. The metaverse, an immersive 3D environment using virtual and augmented reality, is under investigation for healthcare applications. A metaverse-based VR CMR simulation program was developed to assist patients with claustrophobia, but its clinical effectiveness is unexplored. Methods The META-MRI study involved 450 patients screened, with 32 enrolled. They were randomly assigned to intervention (Metaverse-based simulation + standard care) or control (standard care alone). The Metaverse program used a VR headset within the Aimedis metaverse platform. Training sessions occurred before scheduled CMR exams, with anxiolytic treatment when necessary. Primary endpoints included successful CMR completion, anxiety assessment using the State-Trait Anxiety Inventory (STAI), and usability through a questionnaire. Results Patients in the intervention group (n=16) completed Metaverse training successfully. During simulations, anxiety decreased (STAI scores: 73 ± 8 to 51 ± 11, p=0.02). Intervention group completion rate was significantly higher (81%) than the control group (37%) during real CMR exams (p=0.01). Usability scores indicated moderate satisfaction. Discussion The metaverse-based program significantly improved CMR completion rates and reduced anxiety levels in patients with severe claustrophobia compared to standard care alone. Traditional methods for claustrophobia have limitations, making the metaverse a promising tool. Despite promising results, further research is necessary, considering identified usability issues and economic implications. Conclusion This feasibility trial demonstrates the effectiveness of a metaverse-based simulation program in enhancing compliance with CMR exams for patients with severe claustrophobia. The strategy, combined with standard care, led to reduced anxiety and increased CMR completion. Further investigation with larger cohorts is required to validate these findings, addressing usability concerns and assessing the cost-effectiveness of incorporating the metaverse into routine clinical practice.Clinical and demographic characteristics