Music and Paroxysmal Atrial Fibrillation

Shelly A. Challans, BFA, RN, Abraham G. Kocheril, MD, FACC, FACP, FHRS, and Marilyn A. Prasun, PhD, CCNS, FAHA
Millikin University School of
Nursing, Decatur, Illinois; Provena Covenant Medical Center, Urbana, Illinois; and the University of
Illinois College of Medicine at
Urbana-Champaign, Urbana, Illinois

Shelly A. Challans, BFA, RN, Abraham G. Kocheril, MD, FACC, FACP, FHRS, and Marilyn A. Prasun, PhD, CCNS, FAHA
Millikin University School of
Nursing, Decatur, Illinois; Provena Covenant Medical Center, Urbana, Illinois; and the University of
Illinois College of Medicine at
Urbana-Champaign, Urbana, Illinois

Background

Research has documented many positive physiological and emotional effects when listening to music. The use of music to improve health is a concept that dates back to about the sixth century when the Greek philosopher Pythagoras believed that music significantly contributed to health.1 In the mid 1800s, during the Crimean War, Florence Nightingale also recognized the role of music on the healing process and noted that wind or string instruments capable of continuous sound had a beneficial effect.2 Health care practitioners in the early 1900s used music in conjunction with anesthesia to distract patients from surgery.3 Finally, the National Association for Music in Hospitals was established in 1926 by a nurse named Ilsen; this also advocated for the incorporation of music in health care.4

Since that time, data has accumulated which supports the inclusion of music as an augmentative therapy. Research investigating music and cardiovascular health has found benefits in the areas of stress management and relaxation, reduction of heart rate and blood pressure, as well as positive changes in mood and emotional states.5 Further, music has been shown to reduce patients’ perception of pain, alleviate preoperative anxiety, and create positive recovery effects following a heart attack.6 Music listening has been found to provide many of these same beneficial effects among individuals who have already developed coronary heart disease. For these individuals reductions in anxiety, heart rate, and blood pressure were observed. In addition, the amount of oxygen demanded by the heart muscle, an important indicator of the heart muscle’s efficiency, was noted to improve as well.7 Music has also been found to have beneficial effects similar to laughter in dilating blood vessels.8 In this same study, researchers discovered blood vessels narrowed when participants listened to music they perceived as stressful. Therefore, the type and perception of music is important in the therapeutic outcome. What is currently reported to be the best type of music for a therapeutic response is full of character, slow, rhythmically repetitive, dynamically predictable, low in tonal register, harmonically pleasant and void of vocal content.9 Another aspect of the therapeutic response to music is the musical training of the individual. Musicians have been found to have stronger responses as compared to nonmusicians, resulting in a greater reduction in heart rate, respiratory rate, and blood pressure.10 Although there are many considerations to make when bringing music into the healthcare setting, the current literature provides evidence supporting the important therapeutic role of music in cardiovascular health.

Evidence to Date

In 2004, Mackinnon et al conducted a music study on consenting cardiac dysrhythmia patients.8 The purpose of this study was to examine the physiologic effects of live classical harp music on the heart. The conceptual framework of this study focused on heart rate variability as a determining factor of cardiovascular health. Therefore, sinus node recovery time (SNRT), sinoatrial conduction time (SACT), and AA interval were the predominant measurements of interest in this study.8 The results revealed a slowing of the sinus node rate as measured by the AA interval, an increase in the SNRT, and an increase of the SACT.8 These findings indicate decreased sympathetic tone and, as Mackinnon et al pointed out, possibly augmented parasympathetic tone as well. It was concluded that a positive effect on heart rate variability from music exposure occurred due to changes in autonomic tone.8

In addition, Bernardi et al conducted a study in which the impact of various musical qualities on cardiovascular and respiratory function was examined. Musicians were found to have greater sensitivity to music as compared to non-musicians.11 From their findings, Bernardi et al concluded that an arousal effect is induced by music, and this is predominantly evoked by tempo. In 2009, Bernardi et al repeated their study with an added element to examine this entrainment. Mayer waves of blood pressure result from imperfect baroreflex control because of the interaction between a vagal response in heart rate and a sympathetic vascular response.10 It was found that entrainment of cardiovascular autonomic variables did occur in response to this stimuli independent of respiratory modulation.10 This provides important evidence for direct central entrainment of cardiovascular autonomic responses. Replication of musicians’ increased sensitivity to music was observed during this study as well, but musical training was determined to be non-essential to produce entrainment.10

Current Study

We are conducting a non-randomized, prospective, quantitative study in which paroxysmal atrial fibrillation patients scheduled to undergo an electrophysiology study (EPS) are enrolled. This study was submitted to the institutional review boards at Provena Covenant Medical Center in Urbana, Illinois and Millikin University in Decatur, Illinois. Partial support for this study was provided by grant funding from Provena Covenant Medical Center Foundation.

Paroxysmal atrial fibrillation patients identified as a candidate and scheduled for an EPS are presented with the opportunity to participate in this study. Subjects meeting inclusion criteria are ambulatory, non-institutionalized males and females, at least 18 years of age, and able to speak English. Subjects’ primary cardiac rhythm must have originated in the sinoatrial node to qualify for participation. Each subject serves as his/her own control. Individuals who had experienced a myocardial infarction, percutaneous coronary intervention, or bypass surgery within 30 days prior to the study are excluded from participation. Subjects are also excluded if they have any known degree of hearing impairment.

Currently eleven subjects have been enrolled and have participated in the study, with an enrollment of n=28 needed to reach power (0.90). Study subjects’ demographic and medical records are reviewed. Additionally, each subject is asked questions regarding medical history, symptomatology, current medications, and music experience history. During the electrophysiology studies, each subject participating in this study serves as their own control. Baseline data is compared to data collected during the ten-minute music intervention and following the music intervention.

Data collected includes: RR (beat-to-beat), AH (atrial deflection to His bundle deflection), AA (atrial stimulus to atrial stimulus), HV (deflection of His bundle to activation of ventricles) conduction intervals, SACT, SNRT, inducibility of tachyarrhythmias, and effective refractory periods. Heart rate, cardiac cycle length, oxygen saturation, respiratory rate, and myocardial oxygen demand are also recorded at this time and with each subsequent recording of study variables.

Patients primarily receive fentanyl and midazolam as a means of sedation and pain control during the procedure and experience varying levels of sedation. Conscious sedation allows for emphasis of the patients’ subjective judgments of the musical composition, Canon in D, to be lessened during the study.

Conclusion

Many beneficial health effects have been reported from listening to music. At this time, evidence regarding the benefits of music on cardiovascular health is limited. The current research being conducted by Millikin University, Christie Clinic and Provena Covenant Medical Center, and the University of Illinois at Urbana-Champaign, hopes to define specific cardiac effects and further expand our understanding of the important role of music and cardiovascular health. Findings may serve to facilitate incorporation of music into treatment strategies.

References

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  2. Nightingale F. (1992). Notes on Nursing: What It Is, and What It Is Not. Com med. Philadelphia, PA: Lippincott. p.57.
  3. Kane E. The phonograph in the operating room. JAMA 1914;62:1829–1830.
  4. Ilsen, I. How music is used in hospitals. Musician 1926;31–30.
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