Peri-Mitral Atrial Tachycardia Using the Marshall Bundle Epicardial Connections

JACC. Clinical Electrophysiology
Takekuni HayashiShin-Ichi Momomura

Abstract

The aim of this study was to determine whether re-entrant circuits were associated with the ligament of Marshall (LOM). Peri-mitral atrial tachycardias (PMATs) following pulmonary vein isolation (PVI) or mitral valve surgery are common. Six PMATs involving epicardial circuits were identified from 38 patients. Of these, 4 PMATs involved the LOM (PMAT-LOM, mean cycle length 308 ± 53 ms), as confirmed by the insertion of a 2-F electrode in the vein of Marshall (VOM). All patients underwent PVI and mitral isthmus ablation. The PMAT-LOMs were diagnosed based on left atrium (LA) activation maps that covered <90% of tachycardia cycle length (TCL), and a difference between the post-pacing interval and TCL that was: 1) ≤20 ms at the VOM, the ridge between the left pulmonary vein and appendage, the anterior wall of the LA, and along the 6 to 11 o'clock direction of the mitral annulus; and 2) >20 ms at the distal coronary sinus (CS), the posterior wall of the LA, and the mitral isthmus ablation line (or noncapture). Catheter ablation was performed at the ridge for all PMAT-LOMs. Three tachycardias were successfully terminated at the ridge, which showed continuous fractionated potential lasting >100 ms, confirming the bidirectional block o...Continue Reading

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Citations

Jul 15, 2017·Circulation. Arrhythmia and Electrophysiology·Nathaniel ThompsonPierre Jaïs
Mar 25, 2019·Journal of Cardiovascular Electrophysiology·Yoshikazu SatoYoshito Iesaka
Sep 12, 2020·Pacing and Clinical Electrophysiology : PACE·Bo HeZhibing Lu
Apr 25, 2019·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Iwanari KawamuraMasayasu Hiraoka
May 15, 2020·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·P IoannidisI Kanonidis
Nov 17, 2020·Circulation. Arrhythmia and Electrophysiology·Takashi NakashimaNicolas Derval
Mar 21, 2021·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Takamitsu TakagiNicolas Derval
Mar 10, 2021·Pacing and Clinical Electrophysiology : PACE·Konstantinos VlachosMélèze Hocini
May 28, 2019·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Konstantinos VlachosNicolas Derval
Aug 27, 2021·HeartRhythm Case Reports·Wataru SasakiShigeto Naito
Sep 29, 2021·Journal of the American Heart Association·Shinsuke MiyazakiHiroshi Tada
Oct 20, 2021·Journal of Cardiovascular Electrophysiology·Yoshikazu SatoTetsuo Sasano

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