title: Atrial Fibrillation and Beta Thalassemia Major: The Predictive Role of the 12-lead Electrocardiogram Analysis.
abstract: BACKGROUND
  Paroxysmal atrial tachyarrhythmias frequently occur in beta-thalassemia major (β-TM) patients.The aim of our study was to investigate the role of maximum P-wave duration (P max) and dispersion (PD), calculated trough a new manually performed measurement with the use of computer software from all 12-ECG-leads,as predictors of atrial-fibrillation (AF) in β-TM patients with conserved systolic or diastolic cardiac function during a twelve-months follow-up.
  
  
  METHODS
  50 β-TM-patients (age38.4±10.1; 38M) and 50-healthy subjects used as controls, matched for age and gender, were studied for the occurrence of atrial arrhythmias during a 1-year follow-up, through ECG-Holter-monitoring performed every three months. The β-TM-patients were divided into two groups according to number and complexity of premature-supraventricular-complexes at the Holter-Monitoring (Group1: <30/h and no repetitive forms, n:35; Group2: >30/h or couplets, or run of supraventricular tachycardia and AF, n:15).
  
  
  RESULTS
  Compared to the healthy control-group, β-TM patients presented increased P-max (107.5± 21.2 vs 92.1±11ms, P=0.03) and PD-values (41.2±13 vs 25.1±5 ms,P=0.03). In the β-TM population, the Group2 showed a statistically significant increase in PD (42.8±8.6 vs 33.2±6.5ms, P<0.001) and P-max (118.1±8.7 vs 103.1±7.5ms, P<0.001) compared to the Group1. Seven β-TM patients who showed paroxysmal AF during this study had significantly increased P-max and PD than the other patients of the Group2. Moreover, P-max (OR:2.01; CI:1.12-3.59; P=0.01) and PD (OR=2.06;CI:1.17-3.64;P=0.01) demonstrated a statistically significant association with the occurrence of paroxysmal AF,P min was not associated with AF-risk (OR=0.99; CI:0.25-3.40; P=0.9) in β-TM-patients. A cut-off value of 111ms for P-max had a sensitivity of 80% and a specificity of 87%, a cut-off value of 35.5ms for PD had a sensitivity of 90% and a specificity of 85% in identifying β-TM patients at risk for AF.
  
  
  CONCLUSIONS
  Our results indicate that P-max and PD are useful electrocardiographic markers for identifying the β-TM-high-risk patients for AF onset, even when the cardiac function is conserved.
authors.affiliation: Chair of Cardiology, Second University of Naples, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Russo
authors.affiliation: Chair of Cardiology, Second University of Naples, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Rago
authors.affiliation: Internal Medicine Unit, Cardarelli Hospital, Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pannone
authors.affiliation: Chair of Cardiology, Second University of Naples, Naples, Italy.
authors.forename: Andrea Antonio
authors.initials: AA
authors.lastname: Papa
authors.affiliation: Internal Medicine Unit, Cardarelli Hospital, Naples, Italy.
authors.forename: Maria Carolina
authors.initials: MC
authors.lastname: Mayer
authors.affiliation: Internal Medicine Unit, Cardarelli Hospital, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Spasiano
authors.affiliation: Chair of Cardiology, Second University of Naples, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabro
authors.affiliation: Chair of Cardiology, Second University of Naples, Naples, Italy.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.affiliation: Chair of Cardiology, Second University of Naples, Naples, Italy.
authors.forename: Nigro
authors.initials: N
authors.lastname: Gerardo
keywords: P-wave dispersion; atrial fibrillation; beta-thalassemia major