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Ligament and vein of Marshall: A therapeutic opportunity in atrial fibrillation

Published:October 09, 2015DOI:https://doi.org/10.1016/j.hrthm.2015.10.018
      The vein of Marshall (VOM) and the ligament of Marshall (LOM) have been the focus of attention of basic and clinical electrophysiologists for several decades. Their relevance extends beyond that of being mere embryologic remnants of a left superior vena cava; they have been implicated in the pathogenesis of atrial fibrillation (AF), both as a source of initiating triggers
      • Lee S.H.
      • Tai C.T.
      • Hsieh M.H.
      • Tsao H.M.
      • Lin Y.J.
      • Chang S.L.
      • Huang J.L.
      • Lee K.T.
      • Chen Y.J.
      • Cheng J.J.
      • Chen S.A.
      Predictors of non-pulmonary vein ectopic beats initiating paroxysmal atrial fibrillation: implication for catheter ablation.
      as well as a vehicle of parasympathetic
      • Ulphani J.S.
      • Arora R.
      • Cain J.H.
      • Villuendas R.
      • Shen S.
      • Gordon D.
      • Inderyas F.
      • Harvey L.A.
      • Morris A.
      • Goldberger J.J.
      • Kadish A.H.
      The ligament of Marshall as a parasympathetic conduit.
      and sympathetic
      • Kim D.T.
      • Lai A.C.
      • Hwang C.
      • Fan L.T.
      • Karagueuzian H.S.
      • Chen P.S.
      • Fishbein M.C.
      The ligament of Marshall: a structural analysis in human hearts with implications for atrial arrhythmias.
      innervations that modulate electrical properties of atrial tissue and contribute to AF maintenance.
      • Kamanu S.
      • Tan A.Y.
      • Peter C.T.
      • Hwang C.
      • Chen P.S.
      Vein of Marshall activity during sustained atrial fibrillation.
      These properties make the VOM an attractive target during ablation of atrial arrhythmias. Here we review the anatomic and physiologic underpinnings of VOM-related arrhythmogenesis and the data that support targeting it for therapeutic purposes.

      Abbreviations:

      AF (atrial fibrillation), CS (coronary sinus), HFS (high-frequency stimulation), ICN (intracardiac nerve), LA (left atrium), LIPV (left inferior pulmonary vein), LOM (ligament of Marshall), MB (Marshall bundle), MI (mitral isthmus), PMF (perimitral flutter), PV (pulmonary vein), RF (radiofrequency), VOM (vein of Marshall)

      Keywords

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