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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation

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Ethnic differences in atrial fibrillation identified using implanted cardiac devices.

Chu-Pak Lau¹, T David Gbadebo, Stuart J Connolly

¹Queen Mary Hospital, Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, China. cplau@hkucc.hku.hk

Journal of Cardiovascular Electrophysiology

|January 30, 2013

Summary

The Asymptomatic AF and Stroke Evaluation in Pacemaker Patients and the AF Reduction Atrial Pacing Trial (ASSERT) found lower atrial fibrillation (AF) incidence in Black Africans, Chinese, and Japanese individuals compared to Europeans. This occurred despite Black Africans having more AF risk factors.

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Area of Science:

Cardiology
Epidemiology
Medical Devices

Background:

Atrial fibrillation (AF) is perceived as less prevalent in Black and Asian populations, potentially due to reporting biases and healthcare access disparities.
Implantable devices offer a method to detect both symptomatic and asymptomatic AF without ascertainment bias.

Purpose of the Study:

To determine the incidence of asymptomatic atrial fibrillation (AF) across different ethnic groups.
To investigate potential ethnic variations in AF incidence, independent of symptom reporting.

Main Methods:

The ASSERT trial enrolled 2,580 hypertensive patients without a history of AF across North America, Europe, and Asia.
AF was defined by device-recorded episodes exceeding 190 beats/min and lasting >6 minutes or >6 hours.
Ethnic groups included Europeans (n=1900), Black Africans (n=73), Chinese (n=89), and Japanese (n=105).

Main Results:

Over 2.5 years, all non-European groups exhibited a lower incidence of AF compared to Europeans (8.3-10.1% vs. 18.0% for AF >6 minutes).
Chinese patients showed a significantly lower incidence of AF >6 minutes (P < 0.007).
Japanese and Black African patients had a lower incidence of AF >6 hours (P < 0.04 and P = 0.057, respectively).

Conclusions:

Black Africans, Chinese, and Japanese individuals demonstrated a lower incidence of atrial fibrillation compared to Europeans.
Notably, Black Africans exhibited this lower incidence despite a higher prevalence of AF risk factors like heart failure and diabetes.