The RIBAT-AFRICA-AF Registry (Registry Initiative Across Borders for Atrial Fibrillation in Africa)

Abstract

Atrial fibrillation (AF) is associated with substantial morbidity, mortality, and healthcare costs. In African countries, AF management relies on international guidelines largely derived from non-African populations, underscoring the need for region-specific data. To provide real-world African data on the epidemiology, clinical characteristics, diagnostic evaluation, and management of AF. RIBAT-AFRICA-AF is a prospective, multicentre registry including university hospitals and cardiology units across 16 African countries. Patients aged ≥18 years with documented AF (previous or newly diagnosed) were enrolled. Data were collected using a standardized electronic case report form at baseline and at 6 months. The study was registered on ClinicalTrials.gov. Between October 2024 and October 2025, 3,156 patients were enrolled from 29 centres. Mean age was 66 years, and 55% were female. The most frequent cardiovascular risk factors were sedentary lifestyle (61%), hypertension (50%; 62% controlled), and diabetes (40%). Heart failure was present in 44%. AF was newly diagnosed in 57% of patients. Among those with known AF, permanent AF was most common (49%). Prior thromboembolic events were reported in 12%. At diagnosis, 72% were symptomatic. AF was documented on baseline ECG in >75%. Echocardiography revealed left atrial dilatation in >80%, significantly associated with permanent AF (p<0.01) and longer AF duration (p=0.031), particularly using anteroposterior diameter. Preserved LVEF was observed in 53%. Persistent/permanent AF was associated with lower LVEF, while patients in sinus rhythm had higher LVEF (p<0.001). Mitral valve disease was present in 32% (mitral regurgitation 31%; rheumatic mitral stenosis 12%). Antithrombotic therapy mainly involved NOACs (64%). Rate control was the preferred strategy (70%), with adequate rate control in 78%. Rhythm control included pharmacological cardioversion (33%), electrical cardioversion (13%), and catheter ablation (9%). AV node ablation with pacemaker implantation was performed in 3%. At 6 months, all-cause mortality was 4%. Symptom improvement was noted, with 49% in EHRA class I. Thromboembolic events occurred in 2.6%, and 20 patients experienced major extracranial bleeding. RIBAT-AFRICA-AF is the first large-scale prospective AF registry in Africa. It provides important real-world insights into AF epidemiology, clinical profile, and management patterns across African populations.