From Substrate to Strategy: Atrial Cardiomyopathy in Atrial Fibrillation and Heart Failure.

Atrial fibrillation (AF) and heart failure (HF) frequently coexist and mutually exacerbate their progression, morbidity, and risk of adverse clinical outcomes. Increasing evidence supports the concept of atrial cardiomyopathy as a unifying pathophysiological substrate, encompassing structural remodeling, fibrosis, inflammation, myocyte dysfunction, and impaired atrial mechanics. This complex substrate not only predisposes to the development and maintenance of AF, but also contributes to HF symptom burden, thromboembolic risk, and arrhythmia recurrence following therapeutic interventions.Advancements in cardiac imaging and electroanatomic mapping have enabled more precise phenotyping of atrial disease. However, clinical decision-making remains largely based on broad clinical classifications rather than individualized assessment of atrial substrate. There is therefore a critical need to bridge this gap by translating detailed characterization of atrial cardiomyopathy into actionable strategies for risk stratification and patient-specific management.This Research Topic aims to advance the understanding and clinical application of atrial cardiomyopathy in patients with AF and HF, including both heart failure with preserved ejection fraction (HFpEF), mildly-reduced ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF). In particular, it seeks to promote integrative approaches that combine imaging-derived parameters, electrophysiological characteristics, and clinical risk profiles to improve the selection, timing, and effectiveness of rhythm-control strategies. These include pharmacological therapy, electrical cardioversion, catheter ablation, and emerging interventional techniques.We invite contributions that enhance both mechanistic insight and clinical translation, including original research articles, brief reports, clinical studies, technical and validation studies, as well as comprehensive reviews. Topics of interest include, but are not limited to:• Advanced imaging of atrial structure and function (e.g., echocardiography, cardiac magnetic resonance, computed tomography, strain analysis, and fibrosis quantification) and their association with clinical outcomes; • Characterization of the atrial substrate through electroanatomic mapping, circulating biomarkers, and molecular pathways related to fibrosis and inflammation in patients with AF and HF; • Development and validation of risk prediction models for AF recurrence, HF progression, thromboembolic events, and response to rhythm-control interventions; • Substrate-guided and phenotype-based rhythm management strategies, including patient selection for catheter ablation and hybrid approaches; • Standardization, reproducibility, and multicenter validation of metrics and endpoints related to atrial cardiomyopathy. This Research Topic aims to foster a more precise and personalized approach to the management of AF and HF by integrating multidimensional assessment of atrial disease into clinical practice. Topic editors: Flavia Nicoli, Rocco Mollace Source: https://www.frontiersin.org/research-topics/80774/from-substrate-to-strategy-atrial-cardiomyopathy-in-atrial-fibrillation-and-heart-failure