The ligament of Marshall and arrhythmias: A review

He, Bo; Wang, Xiaoying; Zhao, Fang; Guo, Tao; Po, Sunny S.; Lu, Zhibing

doi:10.1111/pace.14071

Cited by 12 publications

(7 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The vein of Marshall (VOM), which obliquely connects the posterolateral wall of left atrial and proximal coronary sinus, is one of the significant components inside the ligament of Marshall (LOM), which is accompanied by multiple structures, including fibrous tissue, blood vessels, muscle bundles, ganglion cells, and autonomic nerves (23). Accumulating studies had revealed that VOM was significantly associated with arrhythmias, and the potential pathophysiology mechanisms between the VOM and atrial arrythmia had been demonstrated, mainly including VOMrelated AT, VOM-related reentrant activities triggering AF, focal activities perpetuating AF, and unbalanced autonomic nervous system in proximal VOM (3). Preliminary clinical researches had reported that ethanol effusion into VOM showed an intriguing effect with inducing a complete linear lesion along the MI and achieving successful MI block (4,5), which made it a promising therapeutic approach for peri-mitral AT or post-AF AT.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis

Sun

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundThe long-term outcomes of ablation with vein of Marshall ethanol infusion (VOM-ABL) compared with ablation alone in patients with atrial fibrillation (AF) remains elusive. We aimed to explore whether VOM-ABL showed better long-term benefits and screen the potential determinants of outcome impact of VOM-ABL procedure.MethodsPubMed, Cochrane Library, Web of Science, and Embase were searched up to 1st September 2021. Studies comparing the long-term (one-year or longer) outcomes between VOM-ABL and ablation alone were included. Subgroup analysis identified potential determinants for VOM-ABL procedure.ResultsCompared with ablation alone, VOM-ABL was associated with a significantly higher rate of long-term freedom from AF/AT (risk ratio [RR], 1.28; 95% confidence interval [CI], 1.12–1.47; p = 0.00) and successful mitral isthmus (MI) block (RR, 1.52; 95% CI, 1.16–1.99; p = 0.00), whereas, there was no significant difference in pericardial effusion, stroke/transient ischemic attack (TIA), and all-cause death. Subgroup analysis identified two significant treatment-covariate interactions: one was ablation strategy subgroup (pulmonary vein isolation plus linear and/or substrate ablation [PVI+]; RR, 1.41; 95% CI, 1.27–1.56 vs. PVI; RR, 1.05; 95% CI, 0.92–1.19, p = 0.00 for interaction) for freedom from AF/AT, while the other was VOM-ABL group sample size subgroup (≥ 100; RR, 1.98; 95% CI, 1.24–3.17 vs. <100; RR, 1.20; 95% CI, 1.10–1.30, p = 0.04 for interaction) for MI block.ConclusionsThis meta-analysis demonstrates that VOM-ABL has superior efficacy and comparable safety over ablation alone in AF patients with long-term follow-up. Moreover, PVI+ and VOM-ABL group sample size ≥ 100 may be associated with a great impact on freedom from AF/AT and MI block, respectively.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Accumulating studies had revealed that the vein of Marshall (VOM) was significantly associated with multiple arrhythmias (e.g., atrial arrhythmias, ventricular arrhythmias, and accessory pathways) (3). Meanwhile, preliminary studies indicated VOM as a promising therapeutic target for AF or post-AF AT.…”

Section: Introductionmentioning

confidence: 99%

The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis

Sun

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…In contrast, EIVOM can effectively affect these epicardial connections and exert a potent intervention to the myocardial AF substrate along the distribution of MB. In addition, EIVOM can eliminate triggering activation of VOM and lead to LA denervation 20 …”

Section: Discussionmentioning

confidence: 99%

Vein of Marshall ethanol infusion: First‐step or adjunctive choice for perimitral atrial tachycardia?

Gao

Sang

Huang

et al. 2022

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background: Perimitral atrial tachycardia (PMAT) is the most frequent type of iatrogenic atrial tachycardia (AT) after atrial fibrillation (AF) ablation. Vein of Marshall ethanol infusion (EIVOM) is a promising technique in mitral isthmus (MI) ablation.Methods: A total of 165 patients with PMAT were divided into three groups according to ablation strategies, including RF only group (n = 89), RF-EIVOM group (initial RF ablation with adjunctive EIVOM, n = 28), and EIVOM-RF group (first-step EIVOM with touch-up RF ablation, n = 48). Acute and follow-up procedure outcomes were evaluated.Results: PMAT terminated in 89.9%, 89.3%, and 93.7% of patients in RF only, RF-EIVOM and EIVOM-RF groups, respectively (p = .715), with complete MI block achieved in 80.9%, 89.3%, and 95.8% of patients (EIVOM-RF vs. RF only, p = .012).First-step utilization of EIVOM was associated with a significant shortening of RF ablation time at MI (EIVOM-RF 2.1 ± 1.3 min, RF only 7.9 ± 5.9 min, RF-EIVOM 6.8 ± 5.8 min; p < .001) and a decrease in the proportion of patients need ablation within coronary sinus (CS, EIVOM-RF 14.6%, RF only 61.8%, RF-EIVOM 64.3%; p < .001). After a mean follow-up of 12.1 ± 6.2 months, AF/AT recurred in 39 (43.8%), 6 (21.4%), and 12 (25.0%) patients in RF only, RF-EIVOM, and EIVOM-RF group (RF-EIVOM vs. RF only, p = .026; EIVOM-RF vs. RF only, p = .022).Conclusions: EIVOM was associated with an enhanced acute MI block rate as well as reduced AF/AT recurrence. First-step utilization of EIVOM promises to significantly simplify the RF ablation process.

show abstract

“…The LOM may play an important role in the pathophysiology of various tachyarrhythmias, including ventricular tachycardias, atrioventricular re-entrant tachycardias, ridge-related perimitral atrial flutters, and atrial fibrillation (AF) ( 11 – 18 ). In patients with AF, the LOM may serve as either a source of triggered ectopic activity ( 8 , 14 , 19 ) or as an arrhythmogenic substrate ( 17 , 18 ).…”

Section: Introductionmentioning

confidence: 99%

Optimization of intra-operative electrophysiological localization of the ligament of Marshall

Langmuur

Taverne²,

Schie³

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundThe ligament of Marshall (LOM) may play a role in the pathophysiology of several tachyarrhythmias and accurate electrophysiological localization of this structure is crucial for effective ablation therapy. This study therefore quantifies electrophysiological properties of the LOM, and identifies which electrogram (EGM) recording (uni- or bipolar) and processing technologies [local activation time (LAT) and/or voltage mapping] are most suitable for accurate localization of the LOM.MethodsThe LOM was electrophysiologically identified in 19 patients (mean age 66 ± 14 years; 12 male) undergoing elective cardiac surgery using intra-operative high-density epicardial mapping, to quantify and visualize EGM features during sinus rhythm.ResultsOnly a third of LOM potentials that were visualized using unipolar EGMs, were still visible in bipolar activation maps. Unipolar LOM potentials had lower voltages (P50: LOM: 1.51 (0.42–4.29) mV vs. left atrium (LA): 8.34 (1.50–17.91) mV, p < 0.001), less steep slopes (P50: LOM: –0.48 (–1.96 to –0.17) V/s vs. LA: –1.24 (–2.59 to –0.21) V/s, p < 0.001), and prolonged activation duration (LOM: 20 (7.5–30.5) ms vs. LA: 16.5 (6–28) ms, p = 0.008) compared to LA potentials. Likewise, bipolar LOM voltages were also smaller (P50: LOM: 1.54 (0.48–3.28) mV vs. LA: 3.12 (0.50–7.19) mV, p < 0.001).ConclusionThe LOM was most accurately localized in activation and voltage maps by using unipolar EGMs with annotation of primary deflections in case of single potentials and secondary deflections in case of double or fractionated potentials.

show abstract

The ligament of Marshall and arrhythmias: A review

Cited by 12 publications

References 40 publications

The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis

The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis

Vein of Marshall ethanol infusion: First‐step or adjunctive choice for perimitral atrial tachycardia?

Optimization of intra-operative electrophysiological localization of the ligament of Marshall

Contact Info

Product

Resources

About