High‐Resolution Mapping and Ablation of Atrial Tachycardias Involving the Lateral Left Atrium

Miyazaki, Shinsuke; Hasegawa, Kanae; Yamao, Kazuya; Mukai, Moe; Aoyama, Daisetsu; Sekihara, Takayuki; Nodera, Minoru; Eguchi, Tomoya; Iesaka, Yoshito; Tada, Hiroshi

doi:10.1161/jaha.121.022384

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…The ridge between the left PVs and LAA is the common site where the MB directly inserts into the LA, and catheter ablation of MB-related tachycardia is reported to be successful at this site. 2 Although we could not record the potentials within the VOM, it is reasonable to conclude that the AP consisted of both the MB and CSM.…”

Section: Discussionmentioning

confidence: 78%

“…1 The vein of Marshall (VOM) plays a significant role in reentrant atrial tachycardia when its distal musculature directly inserts into the left atrium (LA), particularly to the ridge region. 2 Further, the direct insertion of coronary sinus musculature (CSM) into the left ventricle (LV) could coincide with this condition, potentially forming a bypass tract connecting the LA and LV. Only a few case reports have hinted at the involvement of this novel accessory pathway (AP) in orthodromic reciprocating tachycardia (ORT).…”

Section: Introductionmentioning

confidence: 99%

“…The Marshall Bundle (MB), a remnant of the embryonic sinus venosus and left cardinal vein, is a pericardial fold that contains muscle bundles, autonomic innervations, and a small vein 1 . The vein of Marshall (VOM) plays a significant role in reentrant atrial tachycardia when its distal musculature directly inserts into the left atrium (LA), particularly to the ridge region 2 . Further, the direct insertion of coronary sinus musculature (CSM) into the left ventricle (LV) could coincide with this condition, potentially forming a bypass tract connecting the LA and LV.…”

Section: Introductionmentioning

confidence: 99%

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Antidromic and orthodromic reciprocating tachycardias over a novel left‐sided accessory pathway involving the vein of Marshall and coronary sinus musculature

Kanzaki,

Morishima,

Miyazawa

et al. 2023

Cardiovasc electrophysiol

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IntroductionHerein, we present a rare case of the successful ablation of an accessory pathway (AP) involving the Marshall Bundle (MB) and coronary sinus musculature (CSM) in a 40‐year‐old man with Wolff−Parkinson−White syndrome.Methods and ResultsAn orthodromic reciprocating tachycardia (ORT) was inducible with the earliest atrial activation site located at the posterolateral mitral annulus. The local conduction and the cycle length of ORT was prolonged by peri‐mitral ablation; however, it failed to block the AP. The atrial insertion of the AP was identified by remapping during ORT at the left atrial ridge, which was away from the mitral annulus, where ablation was successful. Together with the electrophysiological findings in CSM potentials, we conclude that the epicardial MB‐CSM connection functioned as the AP in this patient.ConclusionThe novel variant form of AP comprised of MB and CSM should be noted. The atrial insertion of the MB may be the target of catheter ablation.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antidromic and orthodromic reciprocating tachycardias over a novel left‐sided accessory pathway involving the vein of Marshall and coronary sinus musculature

Kanzaki,

Morishima,

Miyazawa

et al. 2023

Cardiovasc electrophysiol

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Mapping and ablation of left atrial roof-dependent tachycardias using an ultra-high resolution mapping system

Miyazaki

Hasegawa

Yamao

et al. 2022

BMC Cardiovasc Disord

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Background Left atrial roof-dependent tachycardias (LARTs) are common macroreentrant atrial tachycardias (ATs). We sought to characterize clinical LARTs using an ultra-high resolution mapping system. Methods This study included 22 consecutive LARTs in 21 patients who underwent AT mapping/ablation using Rhythmia systems. Results Three, 13, 4, and 2 LART patients were cardiac intervention naïve (Group-A), post-roof line ablation (Group-B), post-atrial fibrillation ablation without linear ablation (Group-C), and post-cardiac surgery (Group-D), respectively. The mean AT cycle length was 244 ± 43 ms. Coronary sinus activation was proximal-to-distal or distal-to-proximal in 16 (72.7%) ATs. The activation map revealed 13 (59.1%) clockwise and 9 (40.9%) counter-clockwise LARTs. A 12-lead synchronous isoelectric interval was observed in 10/19 (52.6%) LARTs. The slow conduction area was identified on the LA roof, anterior/septal wall, and posterior wall in 18, 6, and 2 ATs, respectively. Twenty concomitant ATs among 13 procedures were also eliminated, and peri-mitral AT coexisted in 7 of 9 non-group-B patients. In group-B, the conduction gap was predominantly located on the mid-roof. Sustained LARTs were terminated by a single application and linear ablation in 6 (27.3%) and 9 (40.9%), while converting to other ATs in 7 (31.8%) LARTs. Complete linear block was created without any complications in all, however, ablation at the mid-posterior wall was required to achieve block in 4 (18.2%) procedures. During 14.0 (6.5–28.5) months of follow-up, 17 (81.0%) and 19 (90.5%) patients were free from any atrial tachyarrhythmias after single and last procedures. Conclusions The LART mechanisms were distinct in individual patients, and elimination of all concomitant ATs was required for the management.

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Morphometric characteristics and histotopography of the left atrium walls

Gaponov

2022

Kazan Med J

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Background. Knowledge of the anatomical features of the left atrium walls will minimize complications during the Cox-Maze surgery. Aim. To clarify common features and local anatomical specificities of the anterosuperior, lateral and inferior walls of the left atrial body of the heart of an adult. Material and methods. From 60 preparations of the hearts of men and women aged 3589 years who died from non-cardiac causes, 61 histotopograms and 180 anatomical sections of the left atrium walls were made. A stereoscopic microscope (4.715 magnification), a histological microscope (40 magnification), and an image recognition program were used. Nonparametric dispersion, correlation, one-way regression analysis were applied. The significance of differences was assessed by the MannWhitney U-test. The results were presented as medians. Results. Anatomical markers of the anterosuperior wall were a compact group of transverse myocardial fibers (anterior interatrial Bachmann bundle) and a thinned section of the lower third of the medial half of the wall. A feature of the lateral wall was a group of oblique myocardial fibers (left lateral ridge). The inferior wall was characterized by well-developed subepicardial tissue. Anteroposterior wall in the medial area (5130 m) and lateral wall (5243 m) were thin. The epicardium with subepicardial tissue in the medial part of the inferior wall was thicker (4750 m) than in the lateral (2651 m) and anterosuperior (2535 m) walls. The myocardium of the anteroposterior wall (2714 m) was thicker than the myocardium of both the lateral (2213 m) and inferior wall in its central (1947 m) and lateral (1913 m) sections. The median thickness of the endocardium of different walls varied from 335 to 426 m. The wall thickness in the upper third mostly depended primarily on the myocardium thickness, and in the inferior third on the epicardium and subepicardial tissue thickness. Conclusion. For the walls of the left atrium, their thickening towards the coronary sulcus was common due to the subepicardial adipose tissue. The peculiarities were the differences of the left atrium walls in thickness and their unique pattern of myocardial anatomy.

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High‐Resolution Mapping and Ablation of Atrial Tachycardias Involving the Lateral Left Atrium

Cited by 3 publications

References 16 publications

Antidromic and orthodromic reciprocating tachycardias over a novel left‐sided accessory pathway involving the vein of Marshall and coronary sinus musculature

Antidromic and orthodromic reciprocating tachycardias over a novel left‐sided accessory pathway involving the vein of Marshall and coronary sinus musculature

Mapping and ablation of left atrial roof-dependent tachycardias using an ultra-high resolution mapping system

Morphometric characteristics and histotopography of the left atrium walls

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