Electrical Isolation of the Marshall Bundle by Radiofrequency Catheter Ablation: In Patients With Atrial Fibrillation

Shin Kashimura, Taishi Fujisawa, Kazuaki Nakajima, Akira Kunitomi, Yoshinori Katsumata, Takahiko Nishiyama, Takehiro Kimura, Nobuhiro Nishiyama, Yoshiyasu Aizawa, Keiichi Fukuda, Seiji Takatsuki

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1647-1657
Number of pages11
JournalJACC: Clinical Electrophysiology
Volume6
Issue number13
DOIs
Publication statusPublished - 2020 Dec 14

Keywords

  • Marshall bundle
  • atrial fibrillation
  • isolation
  • radiofrequency ablation
  • vein of Marshall

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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