Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management
Abstract
:Simple Summary
Abstract
1. Introduction
2. Epidemiology
2.1. Thalassemia
2.2. Atrial Fibrillation in Thalassemia
2.3. Thromboembolism
3. Pathophysiology
4. How to Identify Patients at Risk for Atrial Fibrillation
5. Clinical Features
6. Treatment Options
6.1. Rhythm Control Drugs
- -
- Deferoxamine: this was the first iron chelator introduced in clinical practice. It has a short plasma life and is not absorbed in the gastrointestinal tract, so it must be administered parenterally. Deferoxamine can also be administered in continuous intravenous infusion when intensive chelation is needed [44].
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- Deferiprone: is absorbed by the upper gastrointestinal tract so it can be given orally. It may lead to several adverse effects such as gastrointestinal symptoms, arthropathy and agranulocytosis [45].
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- Deferasirox: can be given orally once a day. It has a good safety profile, and the main adverse effects are gastrointestinal and renal, which are multiple though rare [46].
6.2. Ablation
6.3. Rate Control
6.4. Anticoagulation
7. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Option | Pros | Cons | Caution in Thalassemia | |
---|---|---|---|---|
Rhythm control strategy | Chelation therapy | Effective in preventing both arrhythmic recurrences and iron overload | First line therapy in transfusion-dependent patients | |
Amiodarone | Effective Safe in the short term | Multiple adverse effects in the long term | Frequent coexistence of organ damage (thyroid, liver, skin) | |
Other antiarrhythmic drugs (flecainide, propafenone, sotalol) | Less side effects in the long term | Drug interactions Contraindicated if underlying HF | Possible proarrhythmic effect in patients with iron overload cardiopathy | |
Catheter ablation | Avoiding side effects of antiarrhythmic drugs | Invasive procedure | Atrial structural cardiopathy limiting efficacy | |
Rate control strategy | β-blockers | Effective in reducing symptoms when rhythm control is not possible Indicated also for HF | Negative chronotropic and inotropic effect | Bradycardia may be poorly tolerated |
Calcium channel blockers (verapamil, diltiazem) | Effective in reducing symptoms when rhythm control is not possible | Contraindicated in HF with reduced ejection fraction | Possible coexistence of HF Bradycardia may be poorly tolerated | |
Digoxin | Second line therapy when β-blockers or calcium channel blockers are not tolerated | Small therapeutic window Possibility of overdose | Multiple drug interactions | |
Anticoagulation | Warfarin | Frequent monitoring of coagulation state (INR) | Frequent blood test Labile INR values Less manageable and safe than DOACs | Higher hemorrhagic risk |
DOACs (apixaban, dabigatran, edoxaban, rivaroxaban) | More manageable and safe than warfarin | Higher hemorrhagic risk |
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Malagù, M.; Marchini, F.; Fiorio, A.; Sirugo, P.; Clò, S.; Mari, E.; Gamberini, M.R.; Rapezzi, C.; Bertini, M. Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management. Biology 2022, 11, 148. https://doi.org/10.3390/biology11010148
Malagù M, Marchini F, Fiorio A, Sirugo P, Clò S, Mari E, Gamberini MR, Rapezzi C, Bertini M. Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management. Biology. 2022; 11(1):148. https://doi.org/10.3390/biology11010148
Chicago/Turabian StyleMalagù, Michele, Federico Marchini, Alessio Fiorio, Paolo Sirugo, Stefano Clò, Elisa Mari, Maria Rita Gamberini, Claudio Rapezzi, and Matteo Bertini. 2022. "Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management" Biology 11, no. 1: 148. https://doi.org/10.3390/biology11010148
APA StyleMalagù, M., Marchini, F., Fiorio, A., Sirugo, P., Clò, S., Mari, E., Gamberini, M. R., Rapezzi, C., & Bertini, M. (2022). Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management. Biology, 11(1), 148. https://doi.org/10.3390/biology11010148