Electrophysiological properties and heart rate variability of patients with thalassemia major in Jakarta, Indonesia

PLoS One. 2023 Jan 13;18(1):e0280401. doi: 10.1371/journal.pone.0280401. eCollection 2023.

Abstract

Beta thalassemia major (TM) is a common hereditary disease in Indonesia. Iron overload due to regular transfusion may induce myocardial iron deposition leading to electrophysiological dysfunction and functional disorders of the heart. Ventricular arrhythmia is one of the most common causes of sudden cardiac death in thalassemia patients. This cross-sectional study of 62 TM patients aged 10-32 years in Cipto Mangunkusumo General Hospital was done to assess their electrophysiological properties and heart rate variability, including 24- hour Holter monitoring, signal averaged electrocardiogram (SAECG) for detection of ventricular late potential (VLP), and determination of heart rate variability (HRV). We also assessed their 12-lead ECG parameters, such as P wave, QRS complex, QT/ QTc interval, QRS dispersion, and QT/ QTc dispersion. Iron overload was defined by T2-star magnetic resonance (MR-T2*) values of less than 20 ms or ferritin level greater than 2500 ng/mL. Subjects were grouped accordingly. There were significant differences of QTc dispersion (p = 0.026) and deceleration capacity (p = 0.007) between MR-T2* groups. Multivariate analysis showed an inverse correlation between QTc dispersion and MR-T2* values. There was a proportional correlation between heart rate deceleration capacity in the low MR-T2* group (p = 0.058) and the high ferritin group (p = 0.007). No VLPs were detectable in any patients. In conclusion, prolonged QTc dispersion and decreased heart rate deceleration capacity were significantly correlated with greater odds of iron overload among patients with Thalassemia major.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Sectional Studies
  • Ferritins
  • Heart Rate
  • Humans
  • Indonesia / epidemiology
  • Iron Overload* / diagnosis
  • beta-Thalassemia* / complications

Substances

  • Ferritins

Grants and funding

This research was supported by a Universitas Indonesia Research Grant, with internationally indexed [grant number NKB-1574/UN2.RST/HKP.05.00/2020], received by PAW. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.