Heart Rhythm
Volume 6, Issue 12, Supplement , Pages S35-S40 , December 2009

Ligament of Marshall: Why it is important for atrial fibrillation ablation

  • Chun Hwang, MD

      Affiliations

    • Krannert Institute of Cardiology and the Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
    • Utah Regional Medical Center, Provo, Utah
    • Corresponding Author InformationAddress reprint requests and correspondence: Dr. Chun Hwang, 1800 Capitol Avenue, E410, Indianapolis, Indiana 46228
    • ,
  • Peng-Sheng Chen, MD, FHRS

      Affiliations

    • Krannert Institute of Cardiology and the Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana

References 

  1. Marshall J. On the development of the great anterior veins in man and mammalia: including an account of certain remnants of foetal structure found in the adult, a comparative view of these great veins in the different mammalia, and an analysis of their occasional peculiarities in the human subject. Phil Trans R Soc Lond. 1850;140:133–169
  2. Scherlag BJ, Yeh BK, Robinson MJ. Inferior interatrial pathway in the dog. Circ Res. 1972;31:18–35
  3. Hsu LF, Jais P, Keane D, et al. Atrial fibrillation originating from persistent left superior vena cava. Circulation. 2004;109:828–832
  4. Kamanu S, Tan AY, Peter CT, et al. Vein of Marshall activity during sustained atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17:839–846
  5. Doshi RN, Wu T-J, Yashima M, et al. Relation between ligament of Marshall and adrenergic atrial tachyarrhythmia. Circulation. 1999;100:876–883
  6. Kim DT, Lai AC, Hwang C, et al. The ligament of Marshall: a structural analysis in human hearts with implications for atrial arrhythmias. J Am Coll Cardiol. 2000;36:1324–1327
  7. Hwang C, Peter CT, Chen PS. Radiofrequency ablation of accessory pathways guided by the location of the ligament of Marshall. J Cardiovasc Electrophysiol. 2003;14:616–620
  8. Hwang C, Wu T-J, Doshi RN, et al. Vein of Marshall cannulation for the analysis of electrical activity in patients with focal atrial fibrillation. Circulation. 2000;101:1503–1505
  9. Omichi C, Chou CC, Lee MH, et al. Demonstration of electrical and anatomic connections between Marshall bundles and left atrium in dogs: implications on the generation of P waves on surface electrocardiogram. J Cardiovasc Electrophysiol. 2002;13:1283–1291
  10. Cabrera JA, Ho SY, Climent V, et al. The architecture of the left lateral atrial wall: a particular anatomic region with implications for ablation of atrial fibrillation. Eur Heart J. 2008;29:356–362
  11. Ulphani JS, Arora R, Cain JH, et al. The ligament of Marshall as a parasympathetic conduit. Am J Physiol Heart Circ Physiol. 2007;293:H1629–H1635
  12. Cappato R, Calkins H, Chen SA, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005;111:1100–1105
  13. Coumel P. Autonomic influences in atrial tachyarrhythmias. J Cardiovasc Electrophysiol. 1996;7:999–1007
  14. Hwang C, Fishbein MC, Chen PS. How and when to ablate the ligament of Marshall. Heart Rhythm. 2006;3:1505–1507

 Dr. Chen serves as a consultant for Medtronic, Inc. Supported by National Institutes of Health, National Heart Lung and Blood Institute grants P01 HL78931, R01 HL78932, and 71140, and a Medtronic-Zipes Endowment (Dr. Chen). Dr. Hwang has no conflict of interest.

PII: S1547-5271(09)00966-7

doi: 10.1016/j.hrthm.2009.08.034

Heart Rhythm
Volume 6, Issue 12, Supplement , Pages S35-S40 , December 2009

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