Abstract
The deleterious effects of cardiac iron load on the ventricular repolarization were demonstrated in beta-thalassemia major (βTM), but little is known about the P wave measurements, an independent risk factor for development of atrial fibrillation (AF). We aimed to examine relationship between P-wave parameters and iron loading using cardiac T2* Magnetic Resonance Imaging (MRI) in asymptomatic β-TM patients. The study involved 22 β-TM patients and 22 age- and gender-matched healthy controls. Although P-wave parameters were within normal limits, P max, P min, and Pi were significantly prolonged in the β-TM group compared to the healthy controls (p=0.005, p=0.01, and p=0.03, respectively). Pd was found similar between groups (p=0.46). The prevalence of partial IAB was increased in patients with β-TM (p=0.001) and complete IAB was detected only in one patient. P-wave parameters of patients with cardiac T2* =20 msec were comparable in patients with β-TM. There was no correlation between P-wave parameters and cardiac T2*MRI values. The present study demonstrated that P-wave measurements were slightly affected in β-TM patients with preserved LV functions and this influence was not related with cardiac T2*MRI values. We concluded that the effect of β-TM on the AF development is still controversial.
Highlights
Beta-thalassemia major (β-TM) is a hereditary hemoglinopathy caused by reduced synthesis of β-globin chain and requires frequent blood transfusions [1]
P-wave parameters including maximal P-wave duration (P max) and P-wave dispersion (Pd) on 12-lead ECG were considered as noninvasive predictors of atrial fibrillation (AF) [6,7]
We found that P index (Pi), P max, and P min were significantly prolonged in the β-TM group compared to the controls, but the prolongation did not exceed the normal limits
Summary
Beta-thalassemia major (β-TM) is a hereditary hemoglinopathy caused by reduced synthesis of β-globin chain and requires frequent blood transfusions [1]. In a consequence of blood transfusions, iron accumulates in the heart and may cause heart failure and arrhythmias. It was reported that iron-overload cardiomyopathy is associated with a four- to six-fold increase in the risk of developing atrial fibrillation (AF) [5]. P-wave parameters including maximal P-wave duration (P max) and P-wave dispersion (Pd) on 12-lead ECG were considered as noninvasive predictors of AF [6,7]. A novel parameter, P index (Pi) may independently predict future development of AF in general population. Another novel parameter, interatrial block (IAB) is defined as delayed conduction between the right and left atrium, which results in prolonged P-wave duration (≥110 msec)
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