Qureshi Naveen, Avasarala Kishor, Foote Drucilla, Vichinsky Elliott P
Department of Hematology/Oncology, Children's Hospital & Research Center at Oakland, 747 52nd Street, 2nd floor, Oakland, CA 94609, USA.
Ann N Y Acad Sci. 2005;1054:476-80. doi: 10.1196/annals.1345.064.
Cardiac arrhythmias are among the leading causes of morbidity and mortality of transfusion-dependent, iron-overloaded beta-thalassemia patients. Routine screening with Holter electrocardiogram has been recommended; however, infrequent electrocardiographic changes limit its clinical usefulness. The purpose of this study was to determine the diagnostic yield of Holter electrocardiogram monitoring and its correlation with patient symptoms and disease status. A retrospective analysis was performed on 27 transfusion-dependent thalassemia patients who underwent cardiac questionnaire and Holter screening yearly, in addition to echocardiogram and quantitative iron-level determination. Four patients had clinically significant arrhythmias detected on Holter screening, while 2 patients developed severe cardiac complications secondary to arrhythmias within 1 year of follow-up of normal Holter screening. Early detection of cardiac events among transfusion-dependent thalassemia patients with Holter electrocardiography is not clinically effective. Other screening modalities, including the transtelephonic event recorder, should be evaluated in arrhythmia surveillance.
心律失常是依赖输血、铁过载的β地中海贫血患者发病和死亡的主要原因之一。已建议采用动态心电图进行常规筛查；然而，心电图变化不常见限制了其临床实用性。本研究的目的是确定动态心电图监测的诊断率及其与患者症状和疾病状态的相关性。对27例依赖输血的地中海贫血患者进行了回顾性分析，这些患者除了接受超声心动图检查和定量铁水平测定外，每年还进行心脏问卷调查和动态心电图筛查。4例患者在动态心电图筛查中检测到具有临床意义的心律失常，而2例患者在动态心电图筛查正常的随访1年内因心律失常出现严重心脏并发症。对于依赖输血的地中海贫血患者，通过动态心电图早期检测心脏事件在临床上并无效果。应在心律失常监测中评估其他筛查方式，包括电话传输式事件记录仪。
