Incidence of Symptomatic Arrhythmias and Utilization of Arrhythmia Testing in 10-year Follow up of Cardiac Asymptomatic Hereditary Hemochromatosis Subjects

• Published in: The American journal of cardiology Vol. 157; pp. 153 - 154
• Main Authors: Shizukuda, Yuktiaka, Lingamaneni, Prasanth, Rosing, Douglas R.
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 15.10.2021; Elsevier Limited
• Subjects: Arrhythmia; Asymptomatic; Cardiac arrhythmia; Chronic exposure; EKG; Fibrillation; Gender; Heart; Hemochromatosis; Iron; Overloading; Oxidative stress; Utilization; Ventricle; Volunteers
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2021.07.031

[...]we have speculated that the notion of the arrhythmic potential of the HH population may be more closely associated with decreased left ventricular (LV) systolic function which frequently occurs in untreated HH patients who develop myocardial iron overload, which is indeed arrhythmogenic.8 If our speculation is correct, we would not expect to observe much increase in symptomatic cardiac arrhythmias in our HH cohort as long as the patients were treated with phlebotomy and/or other iron overload reduction therapy to prevent systemic iron overload because these therapies are known to prevent development of LV systolic dysfunction secondary to myocardial iron overload.1,2 On the other hand, we have an additional concern in this population because our HH subjects have shown chronically elevated oxidative stress even under proper systemic iron reduction therapy5,6 and elevated oxidative stress is reported to be associated with the development of atrial fibrillation with chronic exposure.9,10 Therefore, we investigated whether the incidence of atrial fibrillation is higher in our HH cohort as compared to the age gender matched normal volunteer cohort. [...]we only noted development of borderline myocardial iron overload in two HH subjects (T2*, 17 and 18 ms respectively) at the last CMR follow up at the 5-year time point among the subjects with evaluable T2*. Palpitations 1 (8%) 2 (22%) Light headedness/loss of consciousness 2 (15%) 3 (33%) Irregular heartbeats 2 (15%) 3 (33%) Chest pain 1 (8%) 1 (11%) Shortness of breath 1 (8%) 0 Testing: Holter ECG 3 (23%) 2 (22%) EP study 2 (15%) 1 (11%) Diagnosis: Symptomatic arrhythmia 1 (8%) 0 Atrial fibrillation 0 0 Table 1 Incidence of arrhythmias and utilization of arrhythmia testing in 10-year period in cardiac asymptomatic hereditary hemochromatosis subjects and age and gender matched normal volunteers