Atrial cardiomyopathy: from healthy atria to atrial failure. A clinical consensus statement of the Heart Failure Association of the ESC
Weerts, Jerremy Țica, Otilia Aranyo, Julia Basile, Christian Borizanova-Petkova, Angelina Borovac, Josip Andjelo Camilli, Massimiliano Eichenlaub, Martin Fiori, Emiliano Van Loon, Tim
Weerts, Jerremy
Țica, Otilia
Aranyo, Julia
Basile, Christian
Borizanova-Petkova, Angelina
Borovac, Josip Andjelo
Camilli, Massimiliano
Eichenlaub, Martin
Fiori, Emiliano
Van Loon, Tim
Affiliation
Cardiovascular Research Institute Maastricht; University Medical Centre Maastricht; Germans Trias i Pujol University Hospital; University of Birmingham; Emergency County Clinical Hospital of Bihor; University of Naples 'Federico II'; Karolinska Institutet; Medical University Sofia; UMHAT 'Tsaritsa Yoanna-ISUL'; University Hospital of Split; Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart; University of Freiburg; Sapienza University of Rome; University of Groningen; University Medical Center Groningen; Vilnius University; Academic Teaching Hospital University of Freiburg; University of Brescia; Scuola Superiore Sant'Anna; Universitat de Barcelona; Institut d'Investigació August Pi i Sunyer; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares; Athens University Hospital Attikon; National and Kapodistrian University of Athens Medical School; University Duisburg-Essen; Baylor College of Medicine; Montreal Heart Institute; Université de Montréal; Centre of Innovative Medicine Vilnius; Universitätsklinikum des Saarlandes; Saarland University; Heart Research Institute Sydney; St George's University Hospitals NHS Foundation Trust; San Raffaele University of Rome; University Hospital Zurich; University of Zurich; University Medical Center Utrecht; University Hospitals Birmingham NHS Foundation Trust
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Publication date
2025-08-05
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Abstract
The importance of atrial cardiomyopathy (AtCM) as a specific clinical entity is increasingly recognized. Past definitions have varied, and the lack of consistent cut-offs for imaging parameters and biomarkers have limited clinical utility to diagnose and track AtCM progression. While research has mainly focused on AtCM in the context of atrial fibrillation, emerging evidence underscores its relevance in remodelling and development of heart failure. The aim of this consensus document was to provide a contemporary framework for AtCM, evolve the definitions of AtCM and atrial failure for more widespread clinical use, and help to direct emerging research and future clinical trials. Supporting the work of early career researchers, this consensus document evaluates diagnostic markers and summarizes the underpinning mechanisms, clinical characteristics and prognostic impact of AtCM. Our objective was to bring together new translational scientific progress, catalyse future research and enable clinical application to facilitate better management, for example in patient groups where aggressive control of risk factors or comorbidities could prevent AtCM progression. We redefined AtCM as a graded disorder that includes electrical dysfunction of the atria along with evidence of either mechanical atrial dysfunction, atrial enlargement and/or atrial fibrosis. Atrial failure is the end-stage manifestation of AtCM, characterized by progressive structural, electrophysiological and functional changes. Earlier identification, risk stratification and ongoing research into therapeutic options have the potential to prevent the clinical consequences of AtCM and atrial failure, including adverse patient outcomes and poor quality of life associated with atrial fibrillation and heart failure.
Citation
Weerts J, Țica O, Aranyo J, Basile C, Borizanova-Petkova A, Borovac JA, Camilli M, Eichenlaub M, Fiori E, Van Loon T, Withaar C, Zakarkaitė D, Zink MD, Adamo M, Aimo A, Arbelo E, Bisbal Van Bylen F, Farmakis DT, Dobrev D, Čelutkienė J, Böhm M, Coats A, Metra M, Rosano G, Ruschitzka F, Bayes-Genis A, Kotecha D. Atrial cardiomyopathy: From healthy atria to atrial failure. A clinical consensus statement of the Heart Failure Association of the ESC. Eur J Heart Fail. 2025 Aug 5. doi: 10.1002/ejhf.3782. Epub ahead of print.
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Article