Atrial Electrical and Structural Remodeling: Implications for Racial Differences in Atrial Fibrillation

Racial Disparity in AF Electrophysiology. Racial differences in prevalence and incidence rates of atrial fibrillation (AF) are known to exist even after accounting for ascertainment bias, as well as differences in the prevalence of known risk factors. Thus, a different susceptibility to traditional risk factors in different ethnic groups that lead to AF clearly exists. Initiation and maintenance of AF are dependent on triggers, autonomic influence and atrial substrate, and progression to persistent AF occurs by electromechanical remodeling. Genetic differences among the racial group contribute to such differences. This article reviews the electrophysiologic mechanisms for AF, evidence for racial differences in susceptibility to AF, and suggests possible electromechanical reasons for the susceptibility.