Marshall bundle reentrant atrial tachycardia after the Cox‐Maze IV procedure: The last barrier of the conduction pathway between the coronary sinus and left atrium

Abstract

A 74-year-old woman who developed atrial tachycardia following the Cox-Maze IV procedure underwent catheter ablation. The reentrant circuit included the coronary sinus (CS), Marshall bundle (MB), distal MB-left atrial (LA) connection, and anterolateral mitral annulus. The distal MB-LA connection was the last barrier in the conduction pathway between the CS and the left atrium.

Peri‐mitral flutter with epicardial bypass after surgical maze procedure

“…3 Epicardial bypass through the vein of Marshall sometimes causes arrhythmia recurrence after the MI ablation or maze procedure. 4,5 Our case demonstrates that the similar phenomenon across the CS can occur after the surgical maze procedure in which residual myocardial connections in the LA did not exist. The high-density mapping was useful to show the detail tachycardia circuit.…”

“…After the transcutaneous RF MI ablation, residual myocardial connections in the LA may be present and become the cause of arrhythmia recurrence 3 . Epicardial bypass through the vein of Marshall sometimes causes arrhythmia recurrence after the MI ablation or maze procedure 4,5 . Our case demonstrates that the similar phenomenon across the CS can occur after the surgical maze procedure in which residual myocardial connections in the LA did not exist.…”