{"id":"de817b7f9e23","type":"article","url":"https://hartvaat.nl/2026/06/02/autonoom-remodelling-vormt-onafhankelijk-domein-binnen-atriale-cardiomyopathie/","title":"Autonoom remodelling vormt onafhankelijk domein binnen atriale cardiomyopathie","title_en":"Atrial cardiomyopathy as a multidomain disease: longitudinal evidence for autonomic remodelling.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"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","doi":"10.1093/europace/euag132","source_url":"https://doi.org/10.1093/europace/euag132","authors":["Jean-Baptiste Guichard","David Hupin","Vincent Pichot","Sébastien Celle","Inés Martínez Saludes","Ahmed El-Medany","Joseph Barker","Ivo Roca-Luque","Lluís Mont","Antoine Da Costa","Adelina Doltra","Fu Siong Ng","Eduard Guasch","Linda S Johnson","Frédéric Roche"],"significance":6,"published":"2026-08-11","source_date":"2026-06-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/pathofysiologie-af/","https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/"],"congress":"","summary_en":"A prospective cohort study of 670 adults aged 65 years without prior atrial fibrillation demonstrates that autonomic remodelling, assessed via longitudinal heart rate variability, constitutes an independent domain of atrial cardiomyopathy. Involvement of two or more remodelling axes (autonomic, electrical, and structural) was associated with a more than twofold higher risk of incident AF (HR 2.43) and increased rates of major cardiovascular events and mortality. These findings support a multidimensional framework for atrial substrate assessment, suggesting that longitudinal autonomic monitoring may help identify high-risk individuals before clinical arrhythmia onset.","created":"2026-08-05T01:00:34Z","updated":"2026-08-10T10:36:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een prospectief cohortonderzoek onder 670 patiënten van 65 jaar zonder eerder atriumfibrilleren toont aan dat autonome hartritmevariabiliteit een onafhankelijk en progressief domein vormt binnen atriale cardiomyopathie. Deelname aan ≥2 remodellingsdomeinen (autonoom, elektrisch en structureel) werd geassocieerd met een verdubbeling van het AF-risico (HR 2,43) en een toename van cardiovasculaire complicaties en sterfte. Deze bevindingen ondersteunen een meer multidimensionale benadering van het atriale substraat, waarbij longitudinale HRV-metingen kunnen helpen om patiënten met een verhoogd risico te identificeren voordat klinisch AF optreedt.","abstract_original":"AIMS: 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. OBJECTIVES: 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. METHODS AND RESULTS: 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 ≥2 domains exhibited higher risks of AF (HR 2.43; 95% CI 1.72-3.45), major adverse cardiovascular events (HR 1.42), and all-cause mortality (HR 1.35). CONCLUSION: 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."}