Atrial cardiomyopathy - From healthy atria to atrial failure - A clinical consensus statement of the Heart Failure Association of the ESC

Sep 29, 2026

Atrial cardiomyopathy (AtCM) is increasingly recognized as a distinct clinical entity, but prior definitions have varied widely and inconsistent imaging and biomarker cut-offs have limited reliable diagnosis and monitoring of disease progression. While much research has focused on AtCM in atrial fibrillation, accumulating evidence highlights its role in cardiac remodelling and the development of heart failure. This consensus document provides a contemporary clinical framework, updates definitions of AtCM and atrial failure, evaluates diagnostic markers, and summarizes underlying mechanisms to guide research and future trials.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages22

Reading Time55 min

AccessFree to download

Background and rationale

Clinical importance of atrial cardiomyopathy

Limitations of prior definitions

Goals of the consensus document

Contemporary framework for AtCM

Updated definitions for AtCM and atrial failure

Diagnostic and mechanistic content

Diagnostic markers evaluation

Underpinning mechanisms summary

Research and future directions

European Journal of Heart Failure (2025) 27, 2173–2194 POSITION PAPER doi:10.1002/ejhf.3782 Atrial cardiomyopathy: From healthy atria toatrial failure . A clinical consensus statement of the Heart Failure Association of the ESC Jerremy Weerts 1,2†, Otilia T, ica3,4†, Julia Aranyo2, Christian Basile5,6, Angelina Borizanova-Petkova7,8, Josip Andjelo Borovac9, Massimiliano Camilli 10,11, Martin Eichenlaub 12, Emiliano Fiori 13, Tim Van Loon 14, Coenraad Withaar 15, Diana Zakarkait16, Matthias D. Zink17, Marianna Adamo 18, Alberto Aimo 19, Elena Arbelo20,21,22, Felipe Bisbal Van Bylen2,22, Dimitrios T. Farmakis23, Dobromir Dobrev24,25,26, Jelena ˇCelutkien27,28, Michael Böhm29,30, Andrew Coats31, Marco Metra 18, Giuseppe Rosano32,33, Frank Ruschitzka34, Antoni Bayes-Genis2‡, and Dipak Kotecha3,35,36 *‡ 1 Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht, University Medical Centre, Maastricht, The Netherlands; 2 Heart Institute, Germans Trias i Pujol University Hospital, Badalona, Spain; 3 Department of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; 4 Emergency County Clinical Hospital of Bihor, Oradea, Romania; 5 Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy; 6 Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; 7 Department of Emergency Medicine, Medical University Sofia, Sofia, Bulgaria; 8 Cardiology Clinic, UMHAT ‘Tsaritsa Yoanna-ISUL’, Sofia, Bulgaria; 9 Cardiovascular Diseases Department, University Hospital of Split (KBC Split), Split, Croatia; 10Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 11 Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; 12Department of Cardiology and Angiology, Medical Center, University of Freiburg, Bad Krozingen, Germany; 13Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy; 14Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; 15Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 16Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; 17Ortenau-Klinikum Lahr, Academic Teaching Hospital University of Freiburg, Lahr, Germany; 18Cardiology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; 19Cardiology Division, Fondazione Toscana Gabriele Monasterio, Health Sciences Interdisciplinary Center, Scuola Superiore Sant’Anna, Pisa, Italy; 20Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; 21Institut d’Investigació August Pi i Sunyer, Barcelona, Spain; 22 Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; 23 Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece; 24 Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany; 25 Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, USA; 26 Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada; 27 Centre of Innovative Medicine, Vilnius, Lithuania; 28 Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Saarland University, Homburg, Germany; 29 Kardiologie, Angiologie und Internistische Intensivmedizin, Homburg, Germany; 30 Heart Research Institute, Sydney, NSW, Australia; 31CAG Cardiovascular, St George’s University Hospital, London, UK; 32 Department of Human Sciences and Promotion of Quality of Life, San Raffaele University of Rome, Rome,

FAQs

Why are updated definitions of atrial cardiomyopathy needed?

Past definitions differed and imaging/biomarker cut-offs have not been consistent, which limited clinical utility for diagnosing and tracking AtCM progression.

How does atrial cardiomyopathy relate to heart failure development?

Beyond atrial fibrillation, emerging evidence links AtCM with cardiac remodelling and progression toward heart failure.

What does the consensus document provide for clinical practice and research?

It offers a contemporary framework, evolves definitions of AtCM and atrial failure, evaluates diagnostic markers, and summarizes key mechanisms to support ongoing research and future clinical trials.

Sep 29, 2026

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