Development of electrocardiographic anomalies and arrhythmias in adult beta-thalassemia major patients throughout the course of a brief follow-up

Abstract

Thalassemia major (TM) is an inherited blood disorder characterized by chronic anemia due to a lack of production of the necessary globin chains for hemoglobin. To ensure optimal survival, individuals with this condition require regular and ongoing blood transfusions and iron chelation therapy. Excessive iron accumulation can lead to cardiac siderosis, resulting in heart failure and irregular heart rhythms, which are the primary causes of mortality in TM patients. Therefore, it is crucial to identify early signs of cardiac involvement in thalassemia in order to provide preventive and therapeutic interventions. The objective of this study was to observe the progression of abnormal electrocardiographic patterns and arrhythmias in TM patients over a period of 12 months at a tertiary care hospital in India. All participants underwent 24-hour ECG Holter monitoring. The 24-hour recordings were carefully analyzed to identify different types of heartbeats (normal and abnormal), as well as any interference or artifacts. This suggests that the ECG repolarization and autonomic function issues in TM patients without obvious heart failure persist over a short-term follow-up period. While many of these events do not cause symptoms, the occurrence of supraventricular ectopy (abnormal heartbeats originating above the ventricles) and the burden of atrial fibrillation (AF) in this group seem to be severe and develop within a relatively short timeframe of 12 months. Therefore, it is crucial to closely monitor and detect arrhythmias in these patients. Future studies with longer follow-up periods and more comprehensive ECG monitoring will undoubtedly provide a clearer understanding of the specific impact and prognostic significance of certain ECG and arrhythmic markers in this particular context.