P-wave duration as a marker of atrial remodeling in patients referred to ablation for atrial fibrillation: a new stratification tool emerging?

Ablation of atrial fibrillation is one of the most widely applied invasive procedures in the cardiovascular medicine, as populations with atrial fibrillation continuously rise. Recurrence rates are, though, consistently high, even in patients without severe comorbidities. Robust stratification algorithms to distinguish patients suitable for ablation are generally lacking. This is a fact caused by the inability to incorporate evidence of atrial remodeling and fibrosis, e.g. atrial remodeling in the decision pathways. Cardiac magnetic resonance is a powerful tool in identifying fibrosis, it is however costly and not routinely used. Electrocardiography has been in general underutilized in clinical practice regarding the preablative screening. One of the characteristics of the electrocardiogram that can give us valuable data depicting the existence and the extent of atrial remodeling and fibrosis is the duration of the P-wave. For the time being, plenty of data is published that invigorates the implementation of P-wave duration in the routine practice of patient evaluation as a surrogate marker of existing atrial remodeling, that in turn predicts recurrence after ablation of atrial fibrillation. Further research is guaranteed to establish this electrocardiographic characteristic in our stratification quiver.