MUSIC-AF: Personalised music interventions to reduce arrhythmia recurrence after rhythm control in patients with atrial fibrillation

Atrial fibrillation (AF) is a common cardiac arrhythmia characterized by irregular and often rapid electrical activity in the atria of the heart due to a disruption to the normal coordinated contractions¹. AF causes irregular heartbeats and inefficient blood pumping, leading to symptoms such as palpitations, shortness of breath, fatigue, and dizziness. AF increases the risk of stroke, heart failure, other cardiovascular complications and mortality. Moreover, living with AF has a negative impact on mental health, related to increased anxiety (concerning AF episodes and their consequences; and depression². As a result, around 60% of people with AF have impaired health-related Quality of Life (HRQoL) which is also affected by (and affects) symptom burden and psychological function and an increased risk of mortality³. AF also poses a substantial economic burden on healthcare systems due to its high prevalence, frequent hospitalizations, and the need for long-term management⁴. Just in the United Kingdom, the estimated number of AF patients in 2016 was circa 2.16 million (~1.76%)⁵.

Whereas any individual can develop this condition, AF can be influenced by various risk factors that can be classified as ‘wear-and-tear’ (associated with ageing, diet, lifestyle-related habits and other medical conditions), congenital and genetic predispositions⁶. On a population-wide basis, hypertension (HT) is the most common aetiological factor linked to AF with a major impact on the pathogenesis, management, and prognosis of AF⁷. Moreover, it is also one of the potential modifiable AF risk factors⁸ and HT management in people with AF is crucial to reduce the risk of long-term sequelae (e.g., stroke) and mortality.

The first recommended treatment for HT is lifestyle modification (e.g., physical activity, weight loss, healthy diets that include low sodium intake, and reduced alcohol consumption). Lifestyle programmes are also recommended as part of the holistic or integrated care management of AF⁹ apart from stroke prevention (with anticoagulation) and control of the heart rate or rhythm per se. Rhythm control is performed by cardioversion to normal sinus rhythm, or by electrophysiological procedures such as ablation; however, recurrence rates are relatively high after cardioversion (40-50% at 1 year) and ablation (25-30% at 1 year), mostly occurring in the first 2-3 months after the intervention¹.

Whilst drug therapies can mitigate the recurrence of AF after rhythm control, lifestyle changes are also recommended in such patients. Nonetheless, lifestyle changes can be difficult to achieve and sustain, which results in a lack of adherence to management protocols ¹⁰. Hence, it is important to explore alternative pathways that are effective, easy to adopt, and sustainable. Whereas there are no official recommendations, mind-body interventions (e.g., yoga, meditation, mindfulness) have been proposed as potential intervention pathways and some evidence shows that they may improve AF symptoms and as well mental health outcomes¹¹.

Music listening (ML) is a type of mind-body intervention that may offer a complementary, holistic pathway for HT and AF management. Evidence shows that sedative music can reduce both systolic (SBP) and diastolic (DBP) blood pressure^13,14, heart (HR) respiration (RR) rates¹⁵, and increase Heart Rate Variability (HRV)^15,16. Moreover, ML also has well-demonstrated anxiolytic, analgesic, and anti-depressant effects¹⁷ and is a well-established standalone and complementary intervention in a variety of clinical and non-clinical interventions for people of all ages. Nonetheless, very little research has been done in this area and the potential value of ML to self-manage HT and AF, albeit promising, is unknown.

In this Ph.D. project, you will design and evaluate new music-based lifestyle interventions that have the potential to empower people living with AF to have an active role in their health management and help them live better. The project will involve the exploration of the mechanistic underpinnings the potential benefits of music listening for heart health, the co-production of personalised ML interventions with people with lived experience of heart conditions, and a pilot evaluation of these interventions’ acceptability and effectiveness. The overarching aim is to determine whether personalised ML interventions are a viable pathway for AF patients to reduce the recurrence of AF episodes, manage their hypertension, and improve their mental health and quality of life.