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

Rubiana Sukardi, Pustika Amalia Wahidiyat, Phebe Anggita Gultom, Mokhammad Ikhsan, Simon Salim, Mulyadi M. Djer, Muhammad Yamin

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Article numbere0280401
JournalPloS one
Issue number1 January
Publication statusPublished - Jan 2023


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