Aims: Music engagement modulates the autonomic nervous system. Its effect on heart rate variability (HRV) has been documented, but its impact on ventricular repolarisation remains unexplored. Here, we applied time-warping analysis to characterise T-wave morphology changes in musicians across different performance action categories during live ensemble playing and investigate whether the observed changes reflect intrinsic repolarisation modulation beyond heart rate adaptation.
Methods: ECG signals were collected whilst a professional ensemble (violin, cello, piano) performed Schubert's Trio Op.100, Andante con moto, nine times during in-lab rehearsals, with pre-performance baseline and post-performance recovery. The musicians provided annotations of their performance action categories. For each session and category, mean warped T-waves were computed and four morphological markers extracted by comparing each category with the baseline template: temporal (dw) and amplitude (da) differences, and their nonlinear components dw_NL and da_NL. Repeated measures ANOVA with Greenhouse-Geisser correction and linear mixed-effects (LMM) models were applied. Repeated measures correlation assessed the association between T-wave markers and ∆RR.
Results: All four markers were significant in the pianist (p < 0.05), while only dw (p = 0.021) and da (p = 0.045) reached significance in the cellist, with musically intense categories such as Climax showing larger differences. The violinist's data was not usable due to noise. After controlling for RR in LMM, da remained significant in both musicians (both p < 0.01) and da_NL (p < 0.001) in the pianist. In contrast, dw became non-significant in both musicians. Repeated measures correlation confirmed a strong dw–∆RR association.
Conclusion: Significant T-wave morphology differences were observed across musical action categories during performance. Amplitude-domain changes persisted after controlling for heart rate, while overall temporal changes were primarily heart-rate driven, suggesting that music performance modulates ventricular repolarisation dispersion beyond heart-rate adaptation. This work provides a framework for analysing ventricular repolarisation during active music engagement.