Atrial Fibrillation In Middle-Eastern Arabs And South Asians: Studies From A 20-Year National Registry In Qatar

Abstract

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice accounting for approximately one-third of hospitalizations for cardiac rhythm disturbances and is associated with increased risk for stroke, heart failure and death. The epidemiology and clinical features of AF have primarily been characterized in whites of European-descent. The world literature on the epidemiology of AF among different ethnicities is very limited with most of the published reports of AF in non-white ethnicities focusing mainly on black (African-American) patients. The current work represents structured and staged examination of AF in two ethnic groups where very limited literature is available on, namely: Middle Eastern Arabs and South Asians. My original contribution to knowledge includes identification of different aspects of AF in the targeted ethnic groups (Middle Eastern Arabs and South Asians), including: aetiologies; secular trends; cardiovascular risk factors; therapy; and outcome using data from a national registry of cardiovascular diseases in a Middle Eastern country over a 20-years period. In addition, the research undertaken focused on several other aspects peculiar to the effects of AF in these two ethnicities. This included; religious fasting, gender differences, and in high-risk patients including those with chronic kidney disease and acute myocardial infarction. Results of the work fill literature gaps in the clinical features, management and outcomes of AF in the two targeted ethnicities, which serve as essential background for further research to improve outcomes. Moreover, the work included original contributions to general AF knowledge, namely in relation to the effects of fasting and lack of symptoms at presentations, which enriches the world literature of AF. This thesis includes nine publications; seven original papers, one summary paper, and one literature review paper; all published in peer-reviewed journals.