Evaluation of electrocardiogram changes in children with transfusion-dependent β-thalassemia

Background and objectives Cardiac complications are the leading cause of mortality in transfusion-dependent β-thalassemia (β-TDT). While iron overload is a major factor, ECG is an underused tool for early detection of cardiotoxicity in children. Aim The objective was to evaluate ECG abnormalities in pediatric β-TDT patients and correlate them with serum ferritin (SF), age, and chelation regimens. Patients and methods A cross-sectional study of 120 β-TDT children (2–18 years). All underwent 12-lead ECG and echocardiography. ECG parameters included P-wave dispersion (PWD), corrected QT interval/QRS duration, and rhythm analysis. SF and transfusion history were collected. Results ECG abnormalities were observed in 55.8% of patients. PWD related positively with SF, with higher values in those with SF greater than 5000 ng/ml ( P =0.04). Paradoxically, 42% of children less than 10 years had prolonged QRS versus 10% of older children ( P <0.001). Combination chelation was associated with better right ventricular function by TAPSE ( P =0.037). Conclusion Iron overload significantly affects cardiac electrophysiology in β-TDT, with PWD emerging as a sensitive marker of atrial pathology. The high prevalence of conduction abnormalities underscores the value of routine ECG screening. Combination chelation may offer cardio-protective benefits.