Author + information
- Received July 14, 2015
- Accepted August 13, 2015
- Published online February 1, 2016.
- Takekuni Hayashi, MDa,∗ (, )
- Seiji Fukamizu, MDb,
- Takeshi Mitsuhashi, MD, PhDa,
- Takeshi Kitamura, MDb,
- Yuya Aoyama, MDb,
- Rintaro Hojo, MDb,
- Yoshitaka Sugawara, MDa,
- Harumizu Sakurada, MD, PhDc,
- Masayasu Hiraoka, MD, PhDd,
- Hideo Fujita, MD, PhDa and
- Shin-ichi Momomura, MD, PhDa
- aDivision of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- bDepartment of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
- cDepartment of Cardiology, Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan
- dToride Kitasohma Medical Center Hospital, Ibaraki, Japan
- ↵∗Reprint requests and correspondence:
Dr. Takekuni Hayashi, Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Oomiya-ku, Saitama 330-8503, Japan.
Objectives The aim of this study was to determine whether re-entrant circuits were associated with the ligament of Marshall (LOM).
Background Peri-mitral atrial tachycardias (PMATs) following pulmonary vein isolation (PVI) or mitral valve surgery are common.
Methods 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.
Results Three tachycardias were successfully terminated at the ridge, which showed continuous fractionated potential lasting >100 ms, confirming the bidirectional block of Marshall bundle (MB)–LA connections. The remaining tachycardia required ablation for the CS-MB connections, confirming bidirectional block of CS-MB connections.
Conclusions PMAT-LOMs following PVI or valve surgery accounted for up to 11% of PMATs. The bidirectional block of either MB-LA or CS-MB connections is required to eliminate PMAT-LOMs.
- atrial fibrillation
- epicardial mapping
- Marshall bundle
- peri-mitral atrial tachycardia
- radiofrequency catheter ablation
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 14, 2015.
- Accepted August 13, 2015.
- American College of Cardiology Foundation