The role of Marshall bundle epicardial connections in atrial tachycardias after atrial fibrillation ablation

Vlachos, Konstantinos; Denis, Arnaud; Takigawa, Masateru; Kitamura, Τakeshi; Martin, Claire; Frontera, Antonio; Martin, Ruairidh; Bazoukis, George; Bourier, Félix; Cheniti, Ghassen; Duchâteau, Josselin; Thompson, Nathaniel; Massoullié, Grégoire; Lam, Anna; Wolf, Michael; Escande, William; Klotz, Nicolas; Pambrun, Thomas; Sacher, Frédéric; Hocini, Mélèze; Haı̈ssaguerre, Michel; Jaı̈s, Pierre; Derval, Nicolas

doi:10.1016/j.hrthm.2019.05.019

Cited by 91 publications

(113 citation statements)

References 23 publications

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“…Another variant of LA tachycardia is confined to the anterior LA . Localized reentry can occur in various regions in the LA but commonly arises adjacent to prior ablation lesions, as along the ridge between the LA appendage and left pulmonary veins …”

Section: Underlying Substrate For Left Atrial Tachycardiasmentioning

confidence: 99%

“…Ablation in the endocardial aspect of the lateral mitral isthmus could spare epicardial connections, particularly in the ligament of Marshall, and result in slow atrial tachycardias. To completely abolish conduction across the isthmus, it may be necessary to ablate at sites distant from the ablation line, such as along the ridge between the left PVs and the LA appendage or proximally in the CS . Alcohol ablation of the vein of Marshall is also an effective method to abolish conduction across the lateral mitral isthmus …”

Section: Considerations For Effective Ablationmentioning

confidence: 99%

“…commonly arises adjacent to prior ablation lesions, as along the ridge between the LA appendage and left pulmonary veins. 15 Cardiac surgery that involves an atriotomy also predisposes to the late development of organized ATs. Right atriotomies for the repair of congenital heart disease, closure of atrial septal defects, or tricuspid valve surgery can predispose to late ATs and are due to cavotricuspid isthmus-dependent flutter or involve the right atriotomy.…”

Section: Localized Reentry Can Occur In Various Regions In the La Butmentioning

confidence: 99%

“…To completely abolish conduction across the isthmus, it may be necessary to ablate at sites distant from the ablation line, such as along the ridge between the left PVs and the LA appendage or proximally in the CS. 15,37 Alcohol ablation of the vein of Marshall is also an effective method to abolish conduction across the lateral mitral isthmus. 38 The anterior mitral line could prove difficult in the case of thick muscle bundles that exist within Bachmann's bundle and extend over to the LA appendage, thus resulting in non-transmural lesions.…”

Section: Considerations For Effective Ablationmentioning

confidence: 99%

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Approach to catheter ablation of left atrial flutters

Markowitz

Thomas

Liu

et al. 2019

Cardiovasc electrophysiol

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Left atrial tachycardias (ATs) most commonly occur after catheter or surgical ablation of atrial fibrillation and in patients with atrial myopathies. Pre‐existing scar in the left atrium (LA) can result in complex circuits, sometimes with narrow channels that can be detected with high‐resolution mapping. The most common forms of macroreentrant AT from the LA are variants of peri‐mitral and roof‐dependent reentry. Localized reentrant rhythms occur in the setting of fibrosis that gives rise to slow conduction and may occur adjacent to areas of prior ablation. The approach to treating these ATs involves first identifying the left atrial origin, defining the tachycardia circuit – which can be facilitated by ultrahigh density mapping and entrainment – and selecting a suitable isthmus to target for ablation. An important endpoint in ablating left atrial flutters is to establish and confirm bidirectional line of the block. Challenges in ablating these ATs include the presence of multiple tachycardias, defining circuits with complex activation patterns and achieving durable lines of block, particularly in the lateral mitral isthmus. Progress in treating these arrhythmias has come from new mapping technologies and the recognition of epicardial connections that allow for persistent conduction across ablation lesions. Also, advances in delivering energy to obtain complete transmural lesions promise to improve the long‐term success of ablating ATs from the LA.

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Section: Underlying Substrate For Left Atrial Tachycardiasmentioning

confidence: 99%

Section: Considerations For Effective Ablationmentioning

confidence: 99%

Section: Localized Reentry Can Occur In Various Regions In the La Butmentioning

confidence: 99%

Section: Considerations For Effective Ablationmentioning

confidence: 99%

See 2 more Smart Citations

Approach to catheter ablation of left atrial flutters

Markowitz

Thomas

Liu

et al. 2019

Cardiovasc electrophysiol

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show abstract

“…2 The vein of Marshall (VOM) runs along the posterior mitral annulus and is suspected to be implicated in the genesis and maintenance of AF and atrial tachycardias. 3 Ethanol infusion within the VOM has been reported to help in obtaining acute MI block. 4 We present a case where the mitral line was quickly successfully blocked owing to a mechanical bump within the VOM after several conventional endocardial and epicardial ablation attempts.…”

Section: Introductionmentioning

confidence: 99%