🫀From Healthy Atria to Atrial Failure: Rethinking Atrial Cardiomyopathy (AtCM) from the #HFA_ESC clinical consensus statement: 📍AtCM extends beyond #AF: Electrical, mechanical & structural abnormalities may precede clinically apparent AF or #HeartFailure 📍Diagnosis: Electrical atrial dysfunction (P-wave score ≥1) PLUS ≥1 of: mechanical dysfunction, atrial enlargement or excessive atrial fibrosis 📍Proposed diagnostic thresholds: - P-wave ≥120 ms (standard ECG) or ≥150 ms (amplified ECG) - Advanced interatrial block: P-wave ≥120 ms + biphasic morphology in ≥2 inferior leads - LA reservoir strain <23% - LAVi >40 mL/m² (>48 mL/m² in women >65 years) - Atrial fibrosis: thresholds pending validation 📍New P-wave scoring system (0–4): Ranges from normal P-wave (0), prolonged P-wave (1), advanced interatrial block without (2) or with paroxysmal arrhythmia (3), to persistent atrial arrhythmia (4). 📍Atrial failure: End-stage AtCM, characterized by persistent AF or HF with symptoms attributable to atrial disease. 📍Early recognition matters! Risk factor & comorbidity management may help prevent or delay progression to atrial failure. Read more in #EJHF @EJHFEiC 🔗 doi.org/10.1002/ejhf.3782 @escardio @h_arfsten @GTersalvi @jozinetm