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Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control

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Abstract

Background

Atrial fibrillation (AF) affects around 6 million Americans. AF management involves pharmacologic therapy and/or interventional procedures to control rate and rhythm, as well as anticoagulation for stroke prevention. Different populations may respond differently to distinct management strategies. This review will describe disparities in rate and rhythm control and their impact on outcomes among women and historically underrepresented racial and/or ethnic groups.

Methods

This is a narrative review exploring the topic of sex and racial and/or ethnic disparities in rate and rhythm management of AF. We describe basic terminology, summarize AF epidemiology, discuss diversity in clinical research, and review landmark clinical trials.

Results

Despite having higher rates of traditional AF risk factors, Black and Hispanic adults have lower risk of AF than non-Hispanic White (NHW) patients, although those with AF experience more severe symptoms and report lower quality-of-life scores than NHW patients with AF. NHW patients receive antiarrhythmic drugs, cardioversions, and invasive therapies more frequently than Black and Hispanic patients. Women have lower rates of AF than men, but experience more severe symptoms, heart failure, stroke, and death after AF diagnosis. Women and people from diverse racial and ethnic backgrounds are inadequately represented in AF trials; prevalence findings may be a result of underdetection.

Conclusion

Race, ethnicity, and gender are social determinants of health that may impact the prevalence, evolution, and management of AF. This impact reflects differences in biology as well as disparities in treatment and representation in clinical trials.

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References

  1. Schnabel RB, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015;386(9989):154–62.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chugh SS, Blackshear JL, Shen WK, Hammill SC, Gersh BJ. Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol. 2001;37(2):371–8.

    Article  CAS  PubMed  Google Scholar 

  3. Flanagin A, Frey T, Christiansen SL, AMA Manual of Style Committee. Updated guidance on the reporting of race and ethnicity in medical and science journals. JAMA. 2021;326(7):621–7.

    Article  PubMed  Google Scholar 

  4. US Census Bureau, “2020 Census statistics highlight local population changes and nation’s racial and ethnic diversity,” Aug. 2021, Accessed: Jan. 09, 2022. [Online]. Available: https://www.census.gov/newsroom/press-releases/2021/population-changes-nations-diversity.html

  5. Cadava G. The Hispanic Republican: the shaping of an American political identity, from Nixon to Trump. HarperCollins, 2020.

  6. Noe-Bustamante L, Mora L, Lopez MH “About one-in-four US Hispanics have heard of Latinx, but just 3% use it,” Pew Research Center’s Hispanic Trends Project, Aug. 11, 2020. https://www.pewresearch.org/hispanic/2020/08/11/about-one-in-four-u-s-hispanics-have-heard-of-latinx-but-just-3-use-it/ (accessed Jul. 12, 2022).

  7. Mannina C, et al. Frequency of cardiac arrhythmias in older adults: findings from the Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study. Int J Cardiol. 2021;337:64–70.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shulman E, et al. Socioeconomic status and the development of atrial fibrillation in Hispanics, African Americans and non-Hispanic Whites. Clin Cardiol. 2017;40(9):770–6.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shulman E, et al. Heart failure and the development of atrial fibrillation in Hispanics, African Americans and non-Hispanic Whites. Int J Cardiol. 2018;271:186–91.

    Article  PubMed  Google Scholar 

  10. Alonso A, et al. Incidence of atrial fibrillation in Whites and African-Americans: the Atherosclerosis Risk in Communities (ARIC) study. Am Heart J. 2009;158(1):111–7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Perez MV, et al. Risk factors for atrial fibrillation and their population burden in postmenopausal women: the Women’s Health Initiative Observational Study. Heart. 2013;99(16):1173–8.

    Article  PubMed  Google Scholar 

  12. Shen AY-J, et al. Racial/ethnic differences in the prevalence of atrial fibrillation among older adults–a cross-sectional study. J Natl Med Assoc. 2010;102(10):906–13.

    PubMed  Google Scholar 

  13. Dewland TA, Olgin JE, Vittinghoff E, Marcus GM. Incident atrial fibrillation among Asians, Hispanics, Blacks, and Whites. Circulation. 2013;128(23):2470–7.

    Article  PubMed  Google Scholar 

  14. Mou L, et al. Lifetime risk of atrial fibrillation by race and socioeconomic status: ARIC Study (Atherosclerosis Risk in Communities). Circ Arrhythm Electrophysiol. 2018;11(7):e006350.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Virani SS, et al. Heart Disease and Stroke Statistics-2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254–743.

    Article  PubMed  Google Scholar 

  16. Thomas KL, et al. Racial differences in the prevalence and outcomes of atrial fibrillation among patients hospitalized with heart failure. J Am Heart Assoc. 2013;2(5):e000200.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Alonso A, Roetker NS, Soliman EZ, Chen LY, Greenland P, Heckbert SR. Prediction of atrial fibrillation in a racially diverse cohort: the Multi-Ethnic Study of Atherosclerosis (MESA). J Am Heart Assoc. 2016;5(2):e003077.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Reading Turchioe M, et al. Atrial fibrillation and stroke symptoms in the REGARDS study. J Am Heart Assoc. 2022;11(2):e022921.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rodriguez F, et al. Racial and ethnic differences in atrial fibrillation risk factors and predictors in women: findings from the Women’s Health Initiative. Am Heart J. 2016;176:70–7.

    Article  PubMed  Google Scholar 

  20. Marcus GM, et al. European ancestry as a risk factor for atrial fibrillation in African Americans. Circulation. 2010;122(20):2009–15.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Perez MV, et al. African American race but not genome-wide ancestry is negatively associated with atrial fibrillation among postmenopausal women in the Women’s Health Initiative. Am Heart J. 2013;166(3):566-572.e1.

    Article  PubMed  Google Scholar 

  22. Emdin CA, et al. Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ. 2016;532:h7013.

    Article  PubMed  Google Scholar 

  23. Lip GYH, et al. Sex-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Observational Research Programme Pilot survey on Atrial Fibrillation. EP Europace. 2015;17(1):24–31. https://doi.org/10.1093/europace/euu155.

    Article  PubMed  Google Scholar 

  24. Humphries KH, et al. New-onset atrial fibrillation: sex differences in presentation, treatment, and outcome. Circulation. 2001;103(19):2365–70.

    Article  CAS  PubMed  Google Scholar 

  25. Paquette M, et al. Role of gender and personality on quality-of-life impairment in intermittent atrial fibrillation. Am J Cardiol. 2000;86(7):764–8.

    Article  CAS  PubMed  Google Scholar 

  26. Hagens VE, et al. Effect of rate or rhythm control on quality of life in persistent atrial fibrillation. Results from the Rate Control Versus Electrical Cardioversion (RACE) Study. J Am Coll Cardiol. 2004;43(2):241–7.

    Article  PubMed  Google Scholar 

  27. Tamirisa KP, et al. Racial and ethnic differences in the management of atrial fibrillation. CJC Open. 2021;3(12 Suppl):S137–48.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ugowe FE, Jackson LR, Thomas KL. Racial and ethnic differences in the prevalence, management, and outcomes in patients with atrial fibrillation: a systematic review. Heart Rhythm. 2018;15(9):1337–45. https://doi.org/10.1016/j.hrthm.2018.05.019.

    Article  PubMed  Google Scholar 

  29. Heckbert SR, et al. Differences by race/ethnicity in the prevalence of clinically detected and monitor-detected atrial fibrillation: MESA. Circ Arrhythm Electrophysiol. 2020;13(1):e007698.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sarraju A, Maron DJ, Rodriguez F. Under-reporting and under-representation of racial/ethnic minorities in major atrial fibrillation clinical trials. JACC Clinical Electrophysiology. 2020;6(6):739–41. https://doi.org/10.1016/j.jacep.2020.03.001.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Khan MZ, et al. Representation of women, older patients, ethnic, and racial minorities in trials of atrial fibrillation. Pacing Clin Electrophysiol. 2021;44(3):423–31.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Nunes JC, Rice EN, Stafford RS, Lewis EF, Wang PJ. Underrepresentation of ethnic and racial minorities in atrial fibrillation clinical trials. Circ Arrhythm Electrophysiol. 2021;14(12):e010452.

    Article  PubMed  Google Scholar 

  33. January CT, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society. J Am Coll Cardiol. 2019;74(1):104–32.

    Article  PubMed  Google Scholar 

  34. Noubiap JJ, et al. Sex disparities in enrolment and reporting of outcomes by sex in contemporary clinical trials of atrial fibrillation. J Cardiovasc Electrophysiol. 2022. https://doi.org/10.1111/jce.15421.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Volgman AS, et al. Women and atrial fibrillation. J Cardiovasc Electrophysiol. 2021;32(10):2793–807.

    Article  PubMed  Google Scholar 

  36. Salam AM, et al. Atrial fibrillation or flutter during pregnancy in patients with structural heart disease: data from the ROPAC (Registry on Pregnancy and Cardiac Disease). JACC Clin Electrophysiol. 2015;1(4):284–92.

    Article  PubMed  Google Scholar 

  37. Katsi V, et al. Atrial fibrillation in pregnancy: a growing challenge. Curr Med Res Opin. 2017;33(8):1497–504.

    Article  PubMed  Google Scholar 

  38. Lee M, et al. Atrial fibrillation and atrial flutter in pregnant women—a population-based study. J Am Heart Assoc. 2016;5(4):e003182.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Simpson LL. Maternal cardiac disease: update for the clinician. Obstet Gynecol. 2012;119(2 Pt 1):345–59.

    Article  PubMed  Google Scholar 

  40. Wyse DG, Waldo AL, DiMarco JP, Domanski NJ, Rosenberg Y, Schron EB, Kellen JC, Greene HL, Mickel MC, Dalquist JE, Corley SD. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825–33.

    Article  CAS  PubMed  Google Scholar 

  41. Van Gelder IC, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347(23):1834–40.

    Article  PubMed  Google Scholar 

  42. Kirchhof P, et al. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med. 2020;383(14):1305–16.

    Article  PubMed  Google Scholar 

  43. Khan AR, Khan S, Sheikh MA, Khuder S, Grubb B, Moukarbel GV. Catheter ablation and antiarrhythmic drug therapy as first- or second-line therapy in the management of atrial fibrillation: systematic review and meta-analysis. Circ Arrhythm Electrophysiol. 2014;7(5):853–60.

    Article  CAS  PubMed  Google Scholar 

  44. Packer DL, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019;321(13):1261–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Marrouche NF, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378(5):417–27.

    Article  PubMed  Google Scholar 

  46. Bisbal F, et al. Diagnosis-to-ablation time in atrial fibrillation: a modifiable factor relevant to clinical outcome. J Cardiovasc Electrophysiol. 2019;30(9):1483–90.

    Article  PubMed  Google Scholar 

  47. Bunch TJ, et al. Increasing time between first diagnosis of atrial fibrillation and catheter ablation adversely affects long-term outcomes. Heart Rhythm. 2013;10(9):1257–62. https://doi.org/10.1016/j.hrthm.2013.05.013.

    Article  PubMed  Google Scholar 

  48. Kawaji T, et al. Early choice for catheter ablation reduced readmission in management of atrial fibrillation: Impact of diagnosis-to-ablation time. Int J Cardiol. 2019;291:69–76.

    Article  PubMed  Google Scholar 

  49. Hussein AA, et al. Radiofrequency ablation of persistent atrial fibrillation: diagnosis-to-ablation time, markers of pathways of atrial remodeling, and outcomes. Circ Arrhythm Electrophysiol. 2016;9(1):e003669.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Chew DS, et al. Diagnosis-to-ablation time and recurrence of atrial fibrillation following catheter ablation: a systematic review and meta-analysis of observational studies. Circ Arrhythm Electrophysiol. 2020;13(4):e008128.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Piccini JP Sr, et al. Rationale, considerations, and goals for atrial fibrillation centers of excellence: a Heart Rhythm Society perspective. Heart Rhythm. 2020;17(10):1804–32.

    Article  PubMed  Google Scholar 

  52. Hindricks G, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373–498.

    Article  PubMed  Google Scholar 

  53. Calkins H, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275–444.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Zhang Y-Y, et al. Predictors of progression of recently diagnosed atrial fibrillation in REgistry on Cardiac Rhythm DisORDers Assessing the Control of Atrial Fibrillation (RecordAF)–United States cohort. Am J Cardiol. 2013;112(1):79–84. https://doi.org/10.1016/j.amjcard.2013.02.056.

    Article  PubMed  Google Scholar 

  55. Gillott RG, Willan K, Kain K, Sivananthan UM, Tayebjee MH. South Asian ethnicity is associated with a lower prevalence of atrial fibrillation despite greater prevalence of established risk factors: a population-based study in Bradford Metropolitan District. Europace. 2017;19(3):356–63.

    PubMed  Google Scholar 

  56. Golwala H, et al. Racial/ethnic differences in atrial fibrillation symptoms, treatment patterns, and outcomes: insights from Outcomes Registry for Better Informed Treatment for Atrial Fibrillation Registry. Am Heart J. 2016;174:29–36.

    Article  PubMed  Google Scholar 

  57. Kabra R, Cram P, Girotra S, Sarrazin MV. Effect of race on outcomes (stroke and death) in patients >65 years with atrial fibrillation. Am J Cardiol. 2015;116(2):230–5. https://doi.org/10.1016/j.amjcard.2015.04.012.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Magnani JW, et al. Racial differences in atrial fibrillation-related cardiovascular disease and mortality: the Atherosclerosis Risk in Communities (ARIC) study. JAMA Cardiol. 2016;1(4):433–41.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Bush D, Martin LW, Leman R, Chandler M, Haywood LJ, NHLBI AFFIRM Investigators. Atrial fibrillation among African Americans, Hispanics and Caucasians: clinical features and outcomes from the AFFIRM trial. J Natl Med Assoc. 2006;98(3):330–9.

    PubMed  PubMed Central  Google Scholar 

  60. Eberly LA, et al. Racial/ethnic and socioeconomic disparities in management of incident paroxysmal atrial fibrillation. JAMA Netw Open. 2021;4(2):e210247.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Gu K, et al. Racial disparities among Asian Americans with atrial fibrillation: an analysis from the NCDR® PINNACLE Registry. Int J Cardiol. 2021;329:209–16.

    Article  PubMed  Google Scholar 

  62. Thomas KL, et al. Ablation versus drug therapy for atrial fibrillation in racial and ethnic minorities. J Am Coll Cardiol. 2021;78(2):126–38.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Hoyt H, et al. Demographic profile of patients undergoing catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2011;22(9):994–8.

    Article  PubMed  Google Scholar 

  64. Bhave PD, Lu X, Girotra S, Kamel H, Vaughan Sarrazin MS. Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. Heart Rhythm. 2015;12(7):1406–12.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Tamariz L, Rodriguez A, Palacio A, Li H, Myerburg R. Racial disparities in the use of catheter ablation for atrial fibrillation and flutter. Clin Cardiol. 2014;37(12):733–7. https://doi.org/10.1002/clc.22330.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Andrade JG, et al. Cryoballoon ablation as initial treatment for atrial fibrillation: JACC state-of-the-art review. J Am Coll Cardiol. 2021;78(9):914–30.

    Article  PubMed  Google Scholar 

  67. Wazni OM, et al. Cryoballoon ablation as initial therapy for atrial fibrillation. N Engl J Med. 2021;384(4):316–24.

    Article  CAS  PubMed  Google Scholar 

  68. Schnabel RB, et al. Gender differences in clinical presentation and 1-year outcomes in atrial fibrillation. Heart. 2017;103(13):1024–30.

    Article  PubMed  Google Scholar 

  69. Dagres N, et al. Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation. J Am Coll Cardiol. 2007;49(5):572–7.

    Article  PubMed  Google Scholar 

  70. Subramanya V, et al. Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database. BMC Cardiovasc Disord. 2021;21(1):598.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Piccini JP, et al. Differences in clinical and functional outcomes of atrial fibrillation in women and men: two-year results from the ORBIT-AF Registry. JAMA Cardiol. 2016;1(3):282–91.

    Article  PubMed  Google Scholar 

  72. Whitbeck MG, et al. Increased mortality among patients taking digoxin—analysis from the AFFIRM study. Eur Heart J. 2012;34(20):1481–8.

    Article  PubMed  Google Scholar 

  73. Osman MH, Farrag E, Selim M, Osman MS, Hasanine A, Selim A. Cardiac glycosides use and the risk and mortality of cancer; systematic review and meta-analysis of observational studies. PLoS ONE. 2017;12(6):e0178611.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Wassertheil-Smoller S, McGinn AP, Martin L, Rodriguez BL, Stefanick ML, Perez M. The associations of atrial fibrillation with the risks of incident invasive breast and colorectal cancer. Am J Epidemiol. 2017;185(5):372–84. https://doi.org/10.1093/aje/kww185.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Makkar RR, Fromm BS, Steinman RT, Meissner MD, Lehmann MH. Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs. JAMA. 1993;270(21):2590–7.

    Article  CAS  PubMed  Google Scholar 

  76. Benton RE, Sale M, Flockhart DA, Woosley RL. Greater quinidine-induced QTc interval prolongation in women. Clin Pharmacol Ther. 2000;67(4):413–8.

    Article  CAS  PubMed  Google Scholar 

  77. Coughtrie AL, Behr ER, Layton D, Marshall V, John Camm A, Shakir SAW. Drugs and life-threatening ventricular arrhythmia risk: results from the DARE study cohort. BMJ Open. 2017;7(10):e016627. https://doi.org/10.1136/bmjopen-2017-016627.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Pedersen HS, et al. Risk factors and predictors of torsade de pointes ventricular tachycardia in patients with left ventricular systolic dysfunction receiving dofetilide. Am J Cardiol. 2007;100(5):876–80. https://doi.org/10.1016/j.amjcard.2007.04.020.

    Article  CAS  PubMed  Google Scholar 

  79. Essebag V, Hadjis T, Platt RW, Pilote L. Amiodarone and the risk of bradyarrhythmia requiring permanent pacemaker in elderly patients with atrial fibrillation and prior myocardial infarction. J Am Coll Cardiol. 2003;41(2):249–54.

    Article  CAS  PubMed  Google Scholar 

  80. Grönberg T, et al. Can we predict the failure of electrical cardioversion of acute atrial fibrillation? The FinCV study. Pacing Clin Electrophysiol. 2015;38(3):368–75.

    Article  PubMed  Google Scholar 

  81. Gurevitz OT, et al. The effect of patient sex on recurrence of atrial fibrillation following successful direct current cardioversion. Am Heart J. 2006;152(1):155.e9-13.

    Article  PubMed  Google Scholar 

  82. Michelena HI, Powell BD, Brady PA, Friedman PA, Ezekowitz MD. Gender in atrial fibrillation: ten years later. Gend Med. 2010;7(3):206–17.

    Article  PubMed  Google Scholar 

  83. Patel D, et al. Outcomes and complications of catheter ablation for atrial fibrillation in females. Heart Rhythm. 2010;7(2):167–72.

    Article  PubMed  Google Scholar 

  84. Ngo L, Ali A, Ganesan A, Woodman R, Adams R, Ranasinghe I. Gender differences in complications following catheter ablation of atrial fibrillation. Eur Heart J Qual Care Clin Outcomes. 2021;7(5):458–67.

    Article  PubMed  Google Scholar 

  85. Forleo GB, et al. Gender-related differences in catheter ablation of atrial fibrillation. Europace. 2007;9(8):613–20.

    Article  PubMed  Google Scholar 

  86. Dagres N, Clague JR, Breithardt G, Borggrefe M. Significant gender-related differences in radiofrequency catheter ablation therapy. J Am Coll Cardiol. 2003;42(6):1103–7.

    Article  PubMed  Google Scholar 

  87. Hernandez AF, et al. Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure. JAMA. 2007;298(13):1525–32.

    Article  CAS  PubMed  Google Scholar 

  88. Grinfeld L, Rolandi F. Interventions for cardiovascular disease in women. Women’s Health. 2009;5(4):437–46. https://doi.org/10.2217/whe.09.33.

    Article  PubMed  Google Scholar 

  89. Yunus FN, et al. Sex differences in ablation strategy, lesion sets, and complications of catheter ablation for atrial fibrillation: an analysis from the GWTG-AFIB Registry. Circ Arrhythm Electrophysiol. 2021;14(11):e009790.

    Article  PubMed  Google Scholar 

  90. Ferguson JD, Helms A, Mangrum JM, DiMarco JP. Ablation of incessant left atrial tachycardia without fluoroscopy in a pregnant woman. J Cardiovasc Electrophysiol. 2011;22(3):346–9.

    Article  PubMed  Google Scholar 

  91. Szumowski L, et al. Ablation of severe drug-resistant tachyarrhythmia during pregnancy. J Cardiovasc Electrophysiol. 2010;21(8):877–82.

    PubMed  Google Scholar 

  92. Cadrin-Tourigny J, et al. Efficacy of amiodarone in patients with atrial fibrillation with and without left ventricular dysfunction: a pooled analysis of AFFIRM and AF-CHF trials. J Cardiovasc Electrophysiol. 2014;25(12):1306–13. https://doi.org/10.1111/jce.12535.

    Article  PubMed  Google Scholar 

  93. Joglar JA, et al. Effect of carvedilol on survival and hemodynamics in patients with atrial fibrillation and left ventricular dysfunction: retrospective analysis of the US Carvedilol Heart Failure Trials Program. Am Heart J. 2001;142(3):498–501.

    Article  CAS  PubMed  Google Scholar 

  94. Curtis AB, et al. Clinical factors that influence response to treatment strategies in atrial fibrillation: the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J. 2005;149(4):645–9.

    Article  PubMed  Google Scholar 

  95. Rienstra M, et al. Gender-related differences in rhythm control treatment in persistent atrial fibrillation: data of the Rate Control Versus Electrical Cardioversion (RACE) study. J Am Coll Cardiol. 2005;46(7):1298–306.

    Article  PubMed  Google Scholar 

  96. Oza NM, Baveja S, Tedrow U. Bridging the gender gap in atrial fibrillation. Expert Rev Cardiovasc Ther. 2015;13(3):317–23.

    Article  CAS  PubMed  Google Scholar 

  97. Wagstaff AJ, Overvad TF, Lip GYH, Lane DA. Is female sex a risk factor for stroke and thromboembolism in patients with atrial fibrillation? A systematic review and meta-analysis. QJM. 2014;107(12):955–67.

    Article  CAS  PubMed  Google Scholar 

  98. Zhang X-D, et al. Efficacy and safety of catheter ablation for long-standing persistent atrial fibrillation in women. Pacing Clin Electrophysiol. 2013;36(10):1236–44.

    PubMed  Google Scholar 

  99. Kuniss M, et al. Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal atrial fibrillation. Europace. 2021;23(7):1033–41.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Kotecha D, et al. Effect of digoxin vs bisoprolol for heart rate control in atrial fibrillation on patient-reported quality of life: the RATE-AF randomized clinical trial. JAMA. 2020;324(24):2497–508.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  101. Andrade JG, et al. Cryoablation or drug therapy for initial treatment of atrial fibrillation. N Engl J Med. 2021;384(4):305–15.

    Article  CAS  PubMed  Google Scholar 

  102. Devine PG, Forscher PS, Austin AJ, Cox WTL. Long-term reduction in implicit race bias: a prejudice habit-breaking intervention. J Exp Soc Psychol. 2012;48(6):1267–78.

    Article  PubMed  PubMed Central  Google Scholar 

  103. LaVeist TA, Pierre G. Integrating the 3Ds—social determinants, health disparities, and health-care workforce diversity. Public Health Rep. 2014;129(1_suppl2):9–14.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA

    Sofia E. Gomez, Muhammad Fazal, Shayena Shah, Alexander C. Perino, Sanjiv M. Narayan, Fatima Rodriguez & Tina Baykaner

  2. Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA

    Julio C. Nunes

  3. Department of Psychiatry, Yale University, New Haven, CT, USA

    Julio C. Nunes

  4. Cardiac Arrhythmia Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Julio C. Nunes & Janet K. Han

  5. Texas Cardiac Arrhythmia Institute, Dallas, TX, USA

    Kamala P. Tamirisa

  6. David Geffen School of Medicine, UCLA Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA

    Janet K. Han

Authors
  1. Sofia E. Gomez
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  2. Muhammad Fazal
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  3. Julio C. Nunes
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  4. Shayena Shah
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  6. Sanjiv M. Narayan
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  7. Kamala P. Tamirisa
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  8. Janet K. Han
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  9. Fatima Rodriguez
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  10. Tina Baykaner
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Contributions

Conceptualization: SG, MF, FR, TB.

Data collection: SG, MF, JCN, TB.

Interpretation: SG, MF, JCN, SS, SMN, AP, KT, JH, FR, TB.

Writing manuscript: SG, MF, JCN, SS, KT, JH, FR, TB.

Corresponding author

Correspondence to Tina Baykaner.

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Sofia Gomez: none. Muhammad Fazal: none. Julio C. Nunes: none. Shayena Shah: none. Sanjiv Narayan Research Support from NHLBI (5R01HL83359, 5R01HL103800, 5R01HL122384), consulting from Uptodate, TDK Inc, and Abbott Inc. Alexander Perino: none. Kamala Tamirisa: speaker honoraria for Abbott and Medtronic. Janet K. Han: lectureship honoraria for Abbott, Boston Scientific, and Medtronic. Fatima Rodriguez: research support from NHLBI (1K01HL144607), American Heart Association, and Doris Duke Clinical Scientist Development Award. Consulting fees from Novartis, NovoNordisk, and HealthPals. Tina Baykaner: research grant from NIH (K23 HL145017), advisory board for Medtronic, PaceMATE, and BIOTRONIK.

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Gomez, S.E., Fazal, M., Nunes, J.C. et al. Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control. J Interv Card Electrophysiol 66, 1279–1290 (2023). https://doi.org/10.1007/s10840-022-01383-x

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