Author + information
- Received February 4, 2020
- Revision received June 8, 2020
- Accepted June 23, 2020
- Published online September 16, 2020.
- Shin Kashimura, MD,
- Taishi Fujisawa, MD,
- Kazuaki Nakajima, MD, PhD,
- Akira Kunitomi, MD, PhD,
- Yoshinori Katsumata, MD, PhD,
- Takahiko Nishiyama, MD, PhD,
- Takehiro Kimura, MD, PhD,
- Nobuhiro Nishiyama, MD, PhD,
- Yoshiyasu Aizawa, MD, PhD,
- Keiichi Fukuda, MD, PhD and
- Seiji Takatsuki, MD, PhD∗ ()
- ↵∗Address for correspondence:
Dr. Seiji Takatsuki, Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo 160-8582, Japan.
Objectives This study sought to isolate arrhythmogenic Marshall bundles (MBs) by radiofrequency (RF) catheter ablation.
Background The vein of Marshall (VOM) is surrounded by a muscular bundle called the MB. The MB is 1 of the arrhythmogenic sources of atrial fibrillation (AF) and electrically connects to either the left atrial (LA) myocardium or coronary sinus (CS) musculature. By eliminating such electric connections using RF catheter ablation, the MB might be electrically isolated.
Methods This retrospective study included 20 patients (64 ± 10 years old, 5 women) who underwent an MB isolation for nonparoxysmal AF. After pulmonary vein isolation, we performed venography of the VOM and inserted a 2-F electrode catheter into the VOM. RF applications were delivered to eliminate the MB electrograms from both the LA and CS when the MB was considered arrhythmogenic.
Results MB isolation was achieved in 14 patients (70%). Of them, complete or partial MB isolation was accomplished in 7 patients (35%) each. The average number of RF applications in the LA (35 W, 30 s) and CS (25 W, 30 s) was 15 ± 14 and 4 ± 3, respectively. No severe adverse events were observed. During a follow-up of 23 ± 11 months, 18 patients (90%) maintained sinus rhythm.
Conclusions RF applications targeting recordings from an electrode catheter in the VOM were feasible, and the MB could be electrically isolated. Elimination of the MB potentials would be a clear endpoint for patients with an arrhythmogenic MB.
Dr. Takatsuki has received honoraria from Daiichi Sankyo; and honoraria and consulting fees from Medtronic Japan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 4, 2020.
- Revision received June 8, 2020.
- Accepted June 23, 2020.
- 2020 American College of Cardiology Foundation
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