{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T09:51:28Z","timestamp":1782899488320,"version":"3.54.5"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"French Health Ministry"},{"DOI":"10.13039\/501100001677","name":"INSERM","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001677","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University Hospital of Saint-\u00c9tienne"},{"name":"Contractes d\u2019Investigaci\u00f3 Avan\u00e7ada Fundaci\u00f3 BBVA"},{"DOI":"10.13039\/100031015","name":"Hospital Cl\u00ednic Barcelona Joan Rod\u00e9s","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100031015","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Josep Baselga 2022","award":["HCB_BIO_001\/2"],"award-info":[{"award-number":["HCB_BIO_001\/2"]}]},{"name":"Research Grant Daniel Bravo 2024"},{"name":"Foundation Daniel Bravo"},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI19\/00573"],"award-info":[{"award-number":["PI19\/00573"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Atrial cardiomyopathy (AtCM) is increasingly recognized as a substrate for atrial fibrillation (AF), yet its operationalization remains limited and largely marker-driven. Whether autonomic remodelling represents a longitudinally evolving domain within a multidomain framework of AtCM remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine whether autonomic remodelling, assessed through static and longitudinal heart rate variability (HRV) abnormalities, defines a distinct domain of AtCM and contributes to atrial disease burden and clinical risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We studied 670 individuals aged 65 years without prior AF or major cardiovascular disease from the prospective PROOF cohort with 24-h Holter ECGs at baseline and 5 years. Heart rate variability metrics, premature atrial contraction (PAC) burden, and left atrial (LA) size were assessed. Incident AF and cardiovascular outcomes were adjudicated over a median follow-up of 12.1 years. Seventy-two participants (10.7%) developed AF. Static HRV abnormalities and adverse 5-year HRV trajectories were independently associated with subsequent AF. Autonomic abnormalities showed limited concordance with PAC burden and LA enlargement, supporting their role as a distinct AtCM domain. Increasing involvement of remodelling domains was associated with higher risks of AF and cardiovascular outcomes. Participants with \u22652 domains exhibited higher risks of AF (HR 2.43; 95% CI 1.72\u20133.45), major adverse cardiovascular events (HR 1.42), and all-cause mortality (HR 1.35).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Atrial cardiomyopathy is a cumulative, multidomain disease process in which structural, electrical, and autonomic abnormalities define atrial disease burden. Longitudinal autonomic remodelling constitutes an independent and evolving axis within this framework, shifting the focus from isolated arrhythmia detection towards progressive characterization of atrial substrate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag132","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:32:56Z","timestamp":1780399976000},"source":"Crossref","is-referenced-by-count":0,"title":["Atrial cardiomyopathy as a multidomain disease: longitudinal evidence for autonomic remodelling"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-7722","authenticated-orcid":false,"given":"Jean-Baptiste","family":"Guichard","sequence":"first","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona , C\/ Villarroel 170, 08036 Barcelona, Catalonia ,","place":["Spain"]},{"name":"Institut D\u2019Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS) , Villarroel 170, 08036 Barcelona, Catalonia ,","place":["Spain"]},{"name":"National Heart and Lung Institute, Hammersmith Campus, Imperial College London , Du Cane Road, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9032-9031","authenticated-orcid":false,"given":"David","family":"Hupin","sequence":"additional","affiliation":[{"name":"Department of Clinical and Exercise Physiology, University of Jean Monnet, University Hospital of Saint-Etienne, Mines Saint-Etienne, INSERM , U 1059, Saint-Etienne, Saint-Priest-en-Jarez 42270 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0832-4961","authenticated-orcid":false,"given":"Vincent","family":"Pichot","sequence":"additional","affiliation":[{"name":"Department of Clinical and Exercise Physiology, University of Jean Monnet, University Hospital of Saint-Etienne, Mines Saint-Etienne, INSERM , U 1059, Saint-Etienne, Saint-Priest-en-Jarez 42270 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7679-1599","authenticated-orcid":false,"given":"S\u00e9bastien","family":"Celle","sequence":"additional","affiliation":[{"name":"Department of Clinical and Exercise Physiology, University of Jean Monnet, University Hospital of Saint-Etienne, Mines Saint-Etienne, INSERM , U 1059, Saint-Etienne, Saint-Priest-en-Jarez 42270 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9685-1561","authenticated-orcid":false,"given":"In\u00e9s","family":"Mart\u00ednez Saludes","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona , C\/ Villarroel 170, 08036 Barcelona, Catalonia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4419-6693","authenticated-orcid":false,"given":"Ahmed","family":"El-Medany","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Hammersmith Campus, Imperial College London , Du Cane Road, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5483-9608","authenticated-orcid":false,"given":"Joseph","family":"Barker","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Hammersmith Campus, Imperial College London , Du Cane Road, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0731-3731","authenticated-orcid":false,"given":"Ivo","family":"Roca-Luque","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona , C\/ Villarroel 170, 08036 Barcelona, Catalonia ,","place":["Spain"]},{"name":"Institut D\u2019Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS) , Villarroel 170, 08036 Barcelona, Catalonia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8115-5906","authenticated-orcid":false,"given":"Llu\u00eds","family":"Mont","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona , C\/ Villarroel 170, 08036 Barcelona, Catalonia ,","place":["Spain"]},{"name":"Institut D\u2019Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS) , Villarroel 170, 08036 Barcelona, Catalonia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3302-9988","authenticated-orcid":false,"given":"Antoine","family":"Da Costa","sequence":"additional","affiliation":[{"name":"Department of Clinical and Exercise Physiology, University of Jean Monnet, University Hospital of Saint-Etienne, Mines Saint-Etienne, INSERM , U 1059, Saint-Etienne, Saint-Priest-en-Jarez 42270 ,","place":["France"]},{"name":"Cardiology Department, University Hospital of Saint-\u00c9tienne , Saint-\u00c9tienne ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3539-6917","authenticated-orcid":false,"given":"Adelina","family":"Doltra","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona , C\/ Villarroel 170, 08036 Barcelona, Catalonia ,","place":["Spain"]},{"name":"Institut D\u2019Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS) , Villarroel 170, 08036 Barcelona, Catalonia 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D\u2019Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS) , Villarroel 170, 08036 Barcelona, Catalonia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2249-8220","authenticated-orcid":false,"given":"Linda S","family":"Johnson","sequence":"additional","affiliation":[{"name":"Lund University, Department of Clinical Sciences , Lund ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Roche","sequence":"additional","affiliation":[{"name":"Department of Clinical and Exercise Physiology, University of Jean Monnet, University Hospital of Saint-Etienne, Mines Saint-Etienne, INSERM , U 1059, Saint-Etienne, Saint-Priest-en-Jarez 42270 ,","place":["France"]},{"name":"Cardiology Department, University Hospital of Saint-\u00c9tienne , Saint-\u00c9tienne 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