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Published on: December 2, 2014

Atrial cardiomyopathy as a multidomain disease: longitudinal evidence for autonomic remodelling

Jean-Baptiste Guichard1,2,3, David Hupin4, Vincent Pichot4

  • 1Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/ Villarroel 170, 08036 Barcelona, Catalonia, Spain.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|June 30, 2026
PubMed

Insights

Autonomic remodelling, assessed by heart rate variability, is a distinct domain of atrial cardiomyopathy. This evolving factor independently predicts atrial fibrillation and cardiovascular risk, highlighting a multidomain disease process.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Gerontology

Background:

  • Atrial cardiomyopathy (AtCM) is a recognized substrate for atrial fibrillation (AF).
  • The operationalization of AtCM is limited and marker-driven.
  • The role of autonomic remodelling within AtCM requires further clarification.

Purpose of the Study:

  • To determine if autonomic remodelling, via static and longitudinal heart rate variability (HRV) abnormalities, constitutes a distinct AtCM domain.
  • To assess if autonomic remodelling contributes to atrial disease burden and clinical risk.

Main Methods:

  • Prospective study of 670 individuals aged 65+ without prior AF or cardiovascular disease.
  • 24-h Holter ECGs at baseline and 5 years to assess HRV metrics.
  • Adjudication of incident AF and cardiovascular outcomes over a median 12.1-year follow-up.

Main Results:

  • Autonomic abnormalities (HRV) were independently associated with subsequent AF development.
  • Autonomic abnormalities showed limited overlap with premature atrial contraction burden and left atrial size, supporting a distinct domain.
  • Increased involvement of AtCM domains (autonomic, structural, electrical) correlated with higher risks of AF, major adverse cardiovascular events, and mortality.

Conclusions:

  • Atrial cardiomyopathy is a cumulative, multidomain disease involving structural, electrical, and autonomic abnormalities.
  • Longitudinal autonomic remodelling is an independent and evolving axis in AtCM.
  • Focus should shift towards progressive characterization of atrial substrate beyond isolated arrhythmia detection.
Abstract

Keywords:
Atrial cardiomyopathyAtrial fibrillationAutonomic remodellingHeart rate variabilityRisk stratification

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