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

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.