Nedios S, Löbe S, Knopp H, et al. - Because it is important to detect patients with advanced left atrial (LA) remodeling prior to catheter ablation (CA) of atrial fibrillation (AF), therefore, researchers explored echocardiographic parameters related to alterations in anatomy and conduction properties of the LA. They analyzed 75 AF patients before CA, and the intervals from the P‐wave‐onset to four mitral annulus sites were determined via pulsed‐wave tissue Doppler imaging. They categorized patients to an upward U‐pattern (delayed anterior activation) and a downward D‐pattern (earliest LA activation anterior). On multivariate regression, independent predictors of the U‐pattern were: age and diastolic dysfunction. Findings revealed an increased LA asymmetry in AF patients with a U‐pattern. A common reason for this LA activation and remodeling was diastolic dysfunction. Thus, experts inferred that U‐pattern detection signifies advanced AF cases. Also, selection for an appropriate ablation strategy may be facilitated by detection of a U‐pattern.