Marshall vein as arrhythmogenic source in patients with atrial fibrillation: Correlation between its anatomy and electrophysiological findings

被引:57
作者
Kurotobi, Toshiya [1 ]
Ito, Hiroshi [1 ]
Inoue, Koichi [1 ]
Iwakura, Katsuomi [1 ]
Kawano, Shigeo [1 ]
Okamura, Atsunori [1 ]
Date, Motoo [1 ]
Fujii, Kenshi [1 ]
机构
[1] Sakurabashi Watanabe Hosp, Div Cardiol, Kita Ku, Osaka 5300001, Japan
关键词
vein of Marshall; atrial fibrillation; catheter ablation; trigger; atrial premature beats;
D O I
10.1111/j.1540-8167.2006.00542.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Atrial fibrillation (AF) may originate from catecholamine-sensitive vein of Marshall (VOM) or its ligament in addition to pulmonary veins (PVs). The anatomy of VOM and its relation to arrhythmogenic foci in the left atrium are unknown. We studied the anatomy of VOM and its relation to foci in patients with AF. Methods: The study population consisted of 100 patients with AF (mean age, 62 years; chronic AF, n = 15). AF sources were determined at baseline and after isoproterenol administration without sedation. VOM was identified by balloon-occluded coronary sinus (CS) angiography. We determined its anatomy in relation to left PVs. Results: VOM was visualized in 73 patients (73%). Ninety-seven patients had 269 arrhythmogenic foci (PV, n = 77; non-PV, n = 48). Non-PV foci included left atrial posterior wall (24, 9%), left lateral area (12, 4.5%), roof (6, 2.2%), superior vena cava (28, 10.4%), crista terminalis (8, 3.0%), CS (10, 3.7%), and others (10, 3.7%). The incidence of PV foci in the left superior PV (LSPV) was significantly higher in patients with well-developed VOM than in those without (66% vs 42%, P < 0.05). Twenty-eight patients had 30 non-PV foci around the LSPV ostium. We successfully ablated the non-PV foci at the distal end of VOM in 11 patients. The ends of the VOM branches were good markers to search for non-PV foci. Seven of 11 (64%) patients with successful ablation of non-PV foci were free from arrhythmia, whereas only 6 of 17 (35%) were free from arrhythmia in those with residual non-PV foci. Conclusions: To determine VOM anatomy is important to identify non-PV foci around the ends of VOM.
引用
收藏
页码:1062 / 1067
页数:6
相关论文
共 25 条
  • [1] Induction of atrial fibrillation and nerve sprouting by prolonged left atrial pacing in dogs
    Akira, H
    Chang, CM
    Zhou, SM
    Chou, CC
    Yi, J
    Miyauchi, Y
    Okuyama, Y
    Fishbein, MC
    Karagueuzian, HS
    Chen, LS
    Chen, PS
    [J]. PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2003, 26 (12): : 2247 - 2252
  • [2] The anatomic basis of connections between the coronary sinus musculature and the left atrium in humans
    Chauvin, M
    Shah, DC
    Haïssaguerre, M
    Marcellin, L
    Brechenmacher, C
    [J]. CIRCULATION, 2000, 101 (06) : 647 - 652
  • [3] Radiofrequency catheter ablation of atrial fibrillation initiated by spontaneous ectopic beats
    Chen S.-A.
    Tai C.-T.
    Hsieh M.-H.
    Tsai C.-F.
    Lin Y.-K.
    Ding Y.-A.
    Chang M.-S.
    [J]. Current Cardiology Reports, 2000, 2 (4) : 322 - 328
  • [4] Right atrial focal atrial fibrillation: Electrophysiologic characteristics and radiofrequency catheter ablation
    Chen, SA
    Tai, CT
    Yu, WC
    Chen, YJ
    Tsai, CF
    Hsieh, MH
    Chen, CC
    Prakash, VS
    Ding, YA
    Chang, MS
    [J]. JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 1999, 10 (03) : 328 - 335
  • [5] Relation between ligament of Marshall and adrenergic atrial tachyarrhythmia
    Doshi, RN
    Wu, TJ
    Wu, TJ
    Yashima, M
    Kim, YH
    Ong, JJC
    Cao, JM
    Hwang, C
    Yashar, P
    Fishbein, MC
    Karagueuzian, HS
    Chen, PS
    [J]. CIRCULATION, 1999, 100 (08) : 876 - 883
  • [6] Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci
    Haïssaguerre, M
    Jaïs, P
    Shah, DC
    Garrigue, S
    Takahashi, A
    Lavergne, T
    Hocini, M
    Peng, JT
    Roudaut, R
    Clementy, J
    [J]. CIRCULATION, 2000, 101 (12) : 1409 - 1417
  • [7] Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins
    Haïssaguerre, M
    Jaïs, P
    Shah, DC
    Takahashi, A
    Hocini, M
    Quiniou, G
    Garrigue, S
    Le Mouroux, A
    Le Métayer, P
    Clémenty, J
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1998, 339 (10) : 659 - 666
  • [8] Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation -: A prospective randomized study
    Hocini, M
    Jaïs, P
    Sanders, P
    Takahashi, Y
    Rotter, M
    Rostock, T
    Hsu, LF
    Sacher, F
    Reuter, S
    Clémenty, J
    Haïssaguerre, M
    [J]. CIRCULATION, 2005, 112 (24) : 3688 - 3696
  • [9] Atrial fibrillation originating from persistent left superior vena cava
    Hsu, LF
    Jaïs, P
    Keane, D
    Wharton, JM
    Deisenhofer, I
    Hocini, M
    Shah, DC
    Sanders, P
    Scavée, C
    Weerasooriya, R
    Clémenty, J
    Haïssaguerre, M
    [J]. CIRCULATION, 2004, 109 (07) : 828 - 832
  • [10] Idiopathic paroxysmal atrial fibrillation induced by a focal discharge mechanism in the left superior pulmonary vein: Possible roles of the ligament of Marshall
    Hwang, C
    Karagueuzian, KS
    Chen, PS
    [J]. JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 1999, 10 (05) : 636 - 648