Atrial remodeling in patients suffering of atrial fibrillation is related to the stage of disease. During sinus rhythm, the P-wave is a surrogate for atrial electrical activation, but routine 12-lead electrocardiogram (ECG), may not be ideally suited to reflect the atrial electrical activity. In previous work we identified lead position with higher sensitivity for changes in P-wave morphology. In this study we added three novel lead positions to the 12-lead ECG to determine different stages of atrial fibrillation. By means of our novel lead positions and calculations of a signal averaged ECG we were able to describe differences of P-wave morphology for patients with atrial fibrillation compared to a reference cohort and correlated these to the stages of disease for paroxysmal and persistent atrial fibrillation.
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