Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
Heart Rhythm. 2018 Jan;15(1):17-24. doi: 10.1016/j.hrthm.2017.07.033. Epub 2017 Jul 29.
The role of the ligament of Marshall (LOM) in patients with atrial fibrillation (AF) has not been well defined.
The purpose of this study was to describe the role of the LOM in patients with AF and related arrhythmias.
Fifty-six patients (mean age 63 ± 11 years; persistent AF in 48 [86%]; ejection fraction 0.49 ± 0.13; left atrial diameter 4.7 ± 0.6 cm) with LOM-mediated arrhythmias were included.
A LOM-pulmonary vein (PV) connection was present in 18 patients (32%) and was eliminated with radiofrequency (RF) ablation at the left lateral ridge or crux (n = 12), at the mitral annulus (n = 3), or with alcohol/ethanol (EtOH) ablation of the vein of Marshall (VOM; n = 3). A LOM-mediated atrial tachycardia (AT) was present in 13 patients (23%). Thirty-one patients with refractory mitral isthmus conduction were referred for potential EtOH ablation. In the 6 patients in whom VOM was injected during perimitral reentry, EtOH resulted in slowing in 3 patients and termination in 1 patient. In others, EtOH infusion resulted in complete isolation of the left-sided PVs and left atrial appendage. Repeat RF and adjunctive EtOH ablation of the VOM tended to be more effective in creating conduction block across the mitral isthmus than RF ablation alone (P = .057).
The LOM is responsible for a variety of arrhythmia mechanisms in patients with AF and atrial tachycardia. It may be ablated at any point along its course, at the mitral annulus, at the lateral ridge/PV antrum, and epicardially in the coronary sinus and the VOM itself. EtOH ablation of the VOM may be an adjunctive strategy in patients with refractory perimitral reentry.
Marshall 韧带（LOM）在心房颤动（AF）患者中的作用尚未得到很好的定义。
本研究旨在描述 LOM 在 AF 及相关心律失常患者中的作用。
纳入 56 例（平均年龄 63 ± 11 岁；持续性 AF 48 例[86%]；射血分数 0.49 ± 0.13；左心房直径 4.7 ± 0.6 cm）存在 LOM 介导的心律失常的患者。
18 例（32%）患者存在 LOM-肺静脉（PV）连接，通过在左侧侧脊或叉部行射频（RF）消融（n = 12）、在二尖瓣环行 RF 消融（n = 3）或Marshall 静脉（VOM）行乙醇/无水乙醇（EtOH）消融消除了这种连接。13 例（23%）患者存在 LOM 介导的房性心动过速（AT）。31 例二尖瓣峡部传导阻滞难治性患者被转诊行潜在的 EtOH 消融。在 6 例进行二尖瓣旁折返时注入 VOM 的患者中，EtOH 在 3 例患者中导致传导减慢，1 例患者中导致传导终止。在其他患者中，EtOH 输注导致左侧 PV 和左心耳完全隔离。与单独行 RF 消融相比，RF 联合附加的 VOM 行 EtOH 消融更能有效地在二尖瓣峡部形成传导阻滞（P =.057）。
LOM 是 AF 和房性心动过速患者多种心律失常机制的原因。它可以在其任何部位消融，包括二尖瓣环、侧脊/PV 窦、心外膜冠状窦和 VOM 本身。对于难治性二尖瓣旁折返患者，VOM 的 EtOH 消融可能是一种辅助策略。
