Research Article
Volume 10 Issue 8 - 2021
Cardiac Evaluation, Holter Monitoring and Evaluation of Heart Rate Variability in Patients with Thalassemia Major
Ozge Yilmaz1, Meki Bilici2*, Alper Akin2, Murat Soker3, Veysiye Hulya Uzel4, Servet Yel5 and Murat Muhtar Yilmazer2
1Pediatrician, Department of Pediatrics, Dicle University Medical Faculty, Diyarbakir, Turkey
2Pediatric Cardiologist, Associate Professor, Department of Pediatric Cardiology, Dicle University Medical Faculty, Diyarbakır, Turkey
3Professor, Pediatric Hematology and Oncologist, Department of Pediatric Hematology and Oncology, Dicle University Medical Faculty, Diyarbakir, Turkey
4Assiatant Professor, Pediatric Hematology and Oncologist, Department of Pediatric Hematology and Oncology, Dicle University Medical Faculty, Diyarbakir, Turkey
5Assiatant Professor, Pediatrics, Department of Pediatrics, Dicle University Medical Faculty, Diyarbakir, Turkey
*Corresponding Author: Meki Bilici, Pediatric Cardiologist, Associate Professor, Department of Pediatric Cardiology, Dicle University Medical Faculty, Diyarbakır, Turkey.
Received: June 28, 2021; Published: July 30, 2021


Introduction: Cardiac complications due to iron accumulation are the main cause of death in patients with thalassemia major. Our study aimed to investigate the value of heart rate variability in showing the risk of early cardiac exposure and arrhythmia due to iron accumulation and the availability of heart rate variability (HRV) as a noninvasive method in children with major thalassemia.

Material and Methods: This study was carried out at the 24-hour Holter electrocardiography examination by comparing 30 patients with beta-thalassemia major diagnosis and 30 healthy control groups in Dicle University Faculty of Medicine, Department of Pediatric Hematology and Oncology and Pediatric Cardiology.

The heart rate variability, time, and frequency indexes of the two groups were compared. The relationship between serum ferritin levels and HRV parameters was evaluated.

Results: Sixteen of the patients with major thalassemia were girls (53%), 14 were boys (47%) and the mean age was 10. 1 ± 3. 8 years. The 24-hour Holter ECG parameters, maximum heart rate, SDNN, RMSSD, pNN50, TP, LF, and VLF parameters were significantly lower in the patient group than the control group. According to ferritin values, patients were divided into Group I with ferritin values between 1500 - 2500 ng/ml, Group II between 2501 - 5000 ng/ml, and Group III with those over 5000 ng/ml. Heart rate change parameters and groups separated according to ferritin values were compared. The maximum heart rate was significantly higher in Group I compared to Group II and Group III (p = 0.03). There was no significant difference between groups between other parameters. The ectopic hit was detected in eight of the patients. The atrial or ventricular ectopic hit was detected in Holter ECG in four of the 24 patients whose echocardiography findings were normal.

Conclusion: In our study, we found that the value of ferritin alone was not sufficient to indicate cardiac influence. Even if echocardiographic examinations are normal, autonomous dysfunction, atrial and/or ventricular early hit can be detected, so patients with TM should be given 24-hour Holter ECG monitoring as well as echocardiographic examination.

Keywords: Thalassemia Major; Heart Rate Variability; Ferritin


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Citation: Meki Bilici., et al. “Cardiac Evaluation, Holter Monitoring and Evaluation of Heart Rate Variability in Patients with Thalassemia Major”. EC Paediatrics 10.8 (2021): 64-72.

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