Atrial fibrillation prevalence and its management in aging, transfusion-dependent patients with thalassemia: the...

Atrial fibrillation (AF) represents an emerging challenge in thalassemia due to the increasing life expectancy. However, data are limited, and management relies on guidelines for the general population. We conducted a multicenter retrospective study to assess the prevalence of AF in transfusion-dependent beta-thalassemia (β-TDT). Nine centers, observing 1389 patients, participated in the study; 188 patients with a history of AF were included, 61% were male, and 73% splenectomized. The mean age at the first AF episode was 40 years. The prevalence of AF was 11.9%, reaching 31% in individuals aged >66 years. Among the known risk factors, the most common were diabetes, heart failure, and smoking. Regarding disease-specific factors, a history of cardiac iron overload was present in almost half of the patients before AF and in one-third at the time of the first event. Most patients exhibited left atrial dilatation, which can result from anemia. Transcatheter ablation was performed in 26.6% without any complications, and 74.4% reported improvement in symptoms, the primary aim of the procedure. The stroke prevalence was 5.5%, rising to 7.9% when including transient ischemic attacks, with 88% of patients being splenectomized. The CHA2DS2-VASc score was low in more than half of the patients, and 9 events occurred during anticoagulant therapy. This study is, to our knowledge, the first to evaluate AF prevalence in β-TDT, which is higher than in the general population. The CHA2DS2-VASc score has some limitations, and specific guidelines are necessary to provide optimal care for these patients.