Ligament of Marshall

Why it is important for atrial fibrillation ablation

Chun Hwang, Peng-Sheng Chen

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

The ligament of Marshall (LOM) is located on the epicardium between the left atrial appendage and the left pulmonary veins. The corresponding endocardial structure is the left lateral ridge. LOM is a source of paroxysmal AF, and may activate at fast rates during persistent AF. Because of the importance of LOM in the mechanisms of AF, the techniques of LOM ablation are important to the practicing cardiac electrophysiologist. LOM contains muscle bundles (Marshall bundles) that directly connect to atrial myocardium and coronary sinus muscle sleeves. These muscle structures can serve as a source of triggers and drivers for AF, and may form the substrates of reentry. In some patients, these muscle bundles take part in accessory pathway conduction in patients with preexcitation syndrome. LOM can be mapped by either endocardial or epicardial approach. Elimination of the LOM potential during endocardial ablation confirms the successful creation of transmural lesion that includes the LOM. In patients who cannot be mapped or ablated via endocardial approach, epicardial approach is needed to map and ablate the LOM. In addition to the Marshall bundle, the LOM also has rich autonomic innervation. The ganglionated plexi are present in and around the LOM. These ganglionated plexi can be ablated during catheter ablation procedures or during open-heart surgery. In summary, LOM is important in the mechanisms of AF and may participate in accessory pathway conduction in patients with preexcitation syndrome. Mapping and catheter ablation of LOM is both feasible and clinically useful in controlling atrial arrhythmias.

Original languageEnglish
JournalHeart Rhythm
Volume6
Issue number12 SUPPL.
DOIs
StatePublished - Dec 2009

Fingerprint

Ligaments
Atrial Fibrillation
Pre-Excitation Syndromes
Muscles
Catheter Ablation
carbosulfan
Atrial Appendage
Coronary Sinus
Pulmonary Veins
Pericardium
Thoracic Surgery
Cardiac Arrhythmias
Myocardium

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Epicardial mapping and ablation
  • Left atrial flutter
  • Pre-excitation syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ligament of Marshall : Why it is important for atrial fibrillation ablation. / Hwang, Chun; Chen, Peng-Sheng.

In: Heart Rhythm, Vol. 6, No. 12 SUPPL., 12.2009.

Research output: Contribution to journalArticle

@article{404ad0122cdf4b35aab52119d4555a16,
title = "Ligament of Marshall: Why it is important for atrial fibrillation ablation",
abstract = "The ligament of Marshall (LOM) is located on the epicardium between the left atrial appendage and the left pulmonary veins. The corresponding endocardial structure is the left lateral ridge. LOM is a source of paroxysmal AF, and may activate at fast rates during persistent AF. Because of the importance of LOM in the mechanisms of AF, the techniques of LOM ablation are important to the practicing cardiac electrophysiologist. LOM contains muscle bundles (Marshall bundles) that directly connect to atrial myocardium and coronary sinus muscle sleeves. These muscle structures can serve as a source of triggers and drivers for AF, and may form the substrates of reentry. In some patients, these muscle bundles take part in accessory pathway conduction in patients with preexcitation syndrome. LOM can be mapped by either endocardial or epicardial approach. Elimination of the LOM potential during endocardial ablation confirms the successful creation of transmural lesion that includes the LOM. In patients who cannot be mapped or ablated via endocardial approach, epicardial approach is needed to map and ablate the LOM. In addition to the Marshall bundle, the LOM also has rich autonomic innervation. The ganglionated plexi are present in and around the LOM. These ganglionated plexi can be ablated during catheter ablation procedures or during open-heart surgery. In summary, LOM is important in the mechanisms of AF and may participate in accessory pathway conduction in patients with preexcitation syndrome. Mapping and catheter ablation of LOM is both feasible and clinically useful in controlling atrial arrhythmias.",
keywords = "Atrial fibrillation, Catheter ablation, Epicardial mapping and ablation, Left atrial flutter, Pre-excitation syndrome",
author = "Chun Hwang and Peng-Sheng Chen",
year = "2009",
month = "12",
doi = "10.1016/j.hrthm.2009.08.034",
language = "English",
volume = "6",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "12 SUPPL.",

}

TY - JOUR

T1 - Ligament of Marshall

T2 - Why it is important for atrial fibrillation ablation

AU - Hwang, Chun

AU - Chen, Peng-Sheng

PY - 2009/12

Y1 - 2009/12

N2 - The ligament of Marshall (LOM) is located on the epicardium between the left atrial appendage and the left pulmonary veins. The corresponding endocardial structure is the left lateral ridge. LOM is a source of paroxysmal AF, and may activate at fast rates during persistent AF. Because of the importance of LOM in the mechanisms of AF, the techniques of LOM ablation are important to the practicing cardiac electrophysiologist. LOM contains muscle bundles (Marshall bundles) that directly connect to atrial myocardium and coronary sinus muscle sleeves. These muscle structures can serve as a source of triggers and drivers for AF, and may form the substrates of reentry. In some patients, these muscle bundles take part in accessory pathway conduction in patients with preexcitation syndrome. LOM can be mapped by either endocardial or epicardial approach. Elimination of the LOM potential during endocardial ablation confirms the successful creation of transmural lesion that includes the LOM. In patients who cannot be mapped or ablated via endocardial approach, epicardial approach is needed to map and ablate the LOM. In addition to the Marshall bundle, the LOM also has rich autonomic innervation. The ganglionated plexi are present in and around the LOM. These ganglionated plexi can be ablated during catheter ablation procedures or during open-heart surgery. In summary, LOM is important in the mechanisms of AF and may participate in accessory pathway conduction in patients with preexcitation syndrome. Mapping and catheter ablation of LOM is both feasible and clinically useful in controlling atrial arrhythmias.

AB - The ligament of Marshall (LOM) is located on the epicardium between the left atrial appendage and the left pulmonary veins. The corresponding endocardial structure is the left lateral ridge. LOM is a source of paroxysmal AF, and may activate at fast rates during persistent AF. Because of the importance of LOM in the mechanisms of AF, the techniques of LOM ablation are important to the practicing cardiac electrophysiologist. LOM contains muscle bundles (Marshall bundles) that directly connect to atrial myocardium and coronary sinus muscle sleeves. These muscle structures can serve as a source of triggers and drivers for AF, and may form the substrates of reentry. In some patients, these muscle bundles take part in accessory pathway conduction in patients with preexcitation syndrome. LOM can be mapped by either endocardial or epicardial approach. Elimination of the LOM potential during endocardial ablation confirms the successful creation of transmural lesion that includes the LOM. In patients who cannot be mapped or ablated via endocardial approach, epicardial approach is needed to map and ablate the LOM. In addition to the Marshall bundle, the LOM also has rich autonomic innervation. The ganglionated plexi are present in and around the LOM. These ganglionated plexi can be ablated during catheter ablation procedures or during open-heart surgery. In summary, LOM is important in the mechanisms of AF and may participate in accessory pathway conduction in patients with preexcitation syndrome. Mapping and catheter ablation of LOM is both feasible and clinically useful in controlling atrial arrhythmias.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Epicardial mapping and ablation

KW - Left atrial flutter

KW - Pre-excitation syndrome

UR - http://www.scopus.com/inward/record.url?scp=70649092299&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70649092299&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2009.08.034

DO - 10.1016/j.hrthm.2009.08.034

M3 - Article

VL - 6

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 12 SUPPL.

ER -