title: A noninvasive index of atrial remodeling in patients with paroxysmal and persistent atrial fibrillation: a pilot study.
abstract: OBJECTIVE
  This study aims to develop a noninvasive atrial remodeling index (RI) to separate patients presenting paroxysmal atrial fibrillation (ParAF) from those with sustained persistent atrial fibrillation (PerAF), that is, AF episodes interrupted 7 days or more after the onset.
  
  
  METHODS
  Signal-averaged P-wave duration (SAPWd) and left atrial anteroposterior diameter (LADd) were measured in 33 ParAF patients, in 26 sustained PerAF patients, and in 18 control subjects. By using SAPWd and LADd, a dichotomous (0/1) RI was created. A logistic regression model on the probability of having a sustained PerAF vs a ParAF episode was estimated, including the RI, sex, age, and cardiac comorbidities as covariates.
  
  
  RESULTS
  Signal-averaged P-wave duration was significantly longer in sustained PerAF (153 ± 15 milliseconds) than in ParAF patients (142 ± 13 milliseconds, P < .001) and in both ParAF and sustained PerAF groups vs control group (123 ± 7 milliseconds, P < .001). Left atrial anteroposterior diameter was larger both in sustained PerAF (43 ± 6 mm) vs ParAF patients (38 ± 5 mm, P = .002) and in sustained PerAF group vs control group (38 ± 2 mm, P = .004), but no differences were observed between ParAF patients and controls (P = .6). A 12-fold increase (odds ratio, 11.8; 95% confidence interval, 2.2-63.5) in the odds of having a sustained PerAF vs a ParAF episode was observed in patients with RI equal to 1.
  
  
  CONCLUSIONS
  P-wave duration and left atrium diameter enabled to define a noninvasive atrial RI to separate patients with ParAF from those with sustained PerAF. This could be a useful tool to select a suitable strategy for AF treatment.
authors.affiliation: Electrophysiology and Cardiac Pacing Unit, S. Gerardo Hospital, Monza, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vincenti
authors.forename: Matteo
authors.initials: M
authors.lastname: Rota
authors.forename: Monica
authors.initials: M
authors.lastname: Spinelli
authors.forename: Mariella
authors.initials: M
authors.lastname: Corciulo
authors.forename: Sergio
authors.initials: S
authors.lastname: De Ceglia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rovaris
authors.forename: Laura
authors.initials: L
authors.lastname: Antolini
authors.forename: Simonetta
authors.initials: S
authors.lastname: Genovesi
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015897:Comorbidity; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012680:Sensitivity and Specificity