Takigawa Masateru, Miyazaki Shinsuke, Sasano Tetsuo
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.
Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.
J Cardiovasc Dev Dis. 2024 Jun 21;11(7):183. doi: 10.3390/jcdd11070183.
The ligament of Marshall is an epicardial structure characterized by its composition of fat, fibrous tissue, blood vessels, muscle bundles, nerve fibers, and ganglia. Its intricate network forms muscular connections with the coronary sinus and left atrium, alongside adjacent autonomic nerves and ganglion cells. This complexity plays a pivotal role in initiating focal electrical activities and sustaining micro- and macro-reentrant circuits, thereby contributing to the onset of atrial fibrillation and atrial tachycardia. However, endocardial ablation in this area may encounter challenges due to anatomical variations and insulation by fibrofatty tissue. Combining ethanol infusion into the vein of Marshall with radiofrequency ablation presents a promising strategy for effectively and safely eliminating this arrhythmogenic structure and terminating associated tachycardias.
马歇尔韧带是一种心外膜结构，其特征在于由脂肪、纤维组织、血管、肌束、神经纤维和神经节组成。其复杂的网络与冠状窦和左心房形成肌肉连接，以及与相邻的自主神经和神经节细胞相连。这种复杂性在引发局灶性电活动和维持微折返和大折返环路中起关键作用，从而导致心房颤动和房性心动过速的发生。然而，由于解剖变异和纤维脂肪组织的绝缘作用，该区域的心内膜消融可能会遇到挑战。将乙醇注入马歇尔静脉与射频消融相结合，为有效且安全地消除这种致心律失常结构并终止相关心动过速提供了一种有前景的策略。
