Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
JACC Clin Electrophysiol. 2020 Dec 14;6(13):1647-1657. doi: 10.1016/j.jacep.2020.06.025. Epub 2020 Sep 16.
This study sought to isolate arrhythmogenic Marshall bundles (MBs) by radiofrequency (RF) catheter ablation.
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.
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.
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.
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.
本研究旨在通过射频（RF）导管消融来分离致心律失常的Marshall 束（MB）。
Marshall 静脉（VOM）周围有一个称为 MB 的肌肉束。MB 是心房颤动（AF）的致心律失常源之一，与左心房（LA）心肌或冠状窦（CS）肌肉电连接。通过使用 RF 导管消融消除这种电连接，可以实现 MB 的电隔离。
本回顾性研究纳入了 20 名（64±10 岁，女性 5 名）非阵发性 AF 患者，行 MB 隔离术。在肺静脉隔离后，我们对 VOM 进行血管造影，并将 2-F 电极导管插入 VOM。当 MB 被认为是心律失常源时，我们给予 RF 应用以消除 LA 和 CS 中的 MB 电图。
14 名患者（70%）实现了 MB 隔离。其中，7 名患者（35%）实现了完全或部分 MB 隔离，另外 7 名患者（35%）各实现了部分 MB 隔离。LA（35 W，30 s）和 CS（25 W，30 s）的 RF 应用平均次数分别为 15±14 和 4±3。未观察到严重不良事件。在 23±11 个月的随访中，18 名患者（90%）维持窦性心律。
针对 VOM 中电极导管记录进行 RF 应用是可行的，并且可以实现 MB 的电隔离。消除 MB 电位将成为具有致心律失常 MB 的患者的明确终点。
