Identification and Catheter Ablation of Extracardiac and Intracardiac Components of Ligament of Marshall Tissue for Treatment of Paroxysmal Atrial Fibrillation

Katritsis, Demosthenes G.; Ioannidis, John P. A.; Anagnostopoulos, Constantine E.; Sarris, George E.; Giazitzoglou, Eleftherios; Korovesis, Socrates

doi:10.1046/j.1540-8167.2001.00750.x

Cited by 84 publications

(55 citation statements)

References 14 publications

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“…In these patients, many non-PV areas seem to be the source for initiation and maintenance of AF. The most common sites are the superior vena cava, the coronary sinus, the ligament of Marshall, the crista terminalis, the LA posterior wall and the LAA [16,[24][25][26][27]. In the recent BELIEF trial, Di Biase et al showed improved freedom from atrial arrhythmias in patients with longstanding persistent AF who performed empirical electrical isolation of the LAA in addition to standard catheter ablation [17].…”

Section: Discussionmentioning

confidence: 99%

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

Teixeira

Oliveira

Ramos

et al. 2017

J Interv Card Electrophysiol

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Purpose Recurrence of atrial fibrillation (AF) after catheter ablation is common, being clinically relevant to identify predictors of recurrence. The left atrial appendage (LAA) role as an AF trigger is scarcely explored. Our aim was to identify if LAA volume is an independent predictor of AF recurrence after catheter ablation. Methods We analysed 52 patients (aged 54 ± 10 years, 58% male) with paroxysmal and persistent AF who underwent a first AF catheter ablation and had performed contrast-enhanced cardiac computed tomography (CT) prior to the procedure. Results The mean left atrial and LAA volumes measured by cardiac CT were 98.9 ± 31.8 and 9.3 ± 3.5 mL, respectively. All patients received successful pulmonary vein isolation and were followed up for 24 months. AF recurrence occurred in 17 patients (33%). LAA volume was significantly greater in patients with AF recurrence than in those without recurrence (11.3 ± 2.9 vs. 8.2 ± 3.4 mL; p = 0.002). Multivariable analysis using Cox regression revealed that LAA volume (hazard ratio 1.32; 95% confidence interval 1.12-1.55; p = 0.001) and persistent AF (hazard ratio 4.22; 95% confidence interval 1.48-12.07; p = 0.007) were independent predictors for AF recurrence. An LAA volume greater than 8.825 mL predicted AF recurrence with 94% sensitivity and 66% specificity. The Kaplan-Meier analysis showed a lower rate free from AF recurrence in the group with an LAA volume >8.825 mL (p < 0.001).Conclusions Larger LAA volume was associated with AF recurrence after catheter ablation in patients with paroxysmal and persistent AF.

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Section: Discussionmentioning

confidence: 99%

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

Teixeira

Oliveira

Ramos

et al. 2017

J Interv Card Electrophysiol

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“…[7][8][9][10][11][12][13][14] The most common sites are the superior vena cava, ligament of Marshall, coronary sinus, crista terminalis, and LA posterior wall. The reported incidence of extra-PV initiators varies from 3.2% to 47%.…”

Section: Previous Studiesmentioning

confidence: 99%

“…The reported incidence of extra-PV initiators varies from 3.2% to 47%. [7][8][9][10][11][12][13][14] Our study is the first to report firing from the LAA as a possible site of origin of AF in a consecutive series of patients. The prevalence of this finding in our population was 27%.…”

Section: Previous Studiesmentioning

confidence: 99%

Left Atrial Appendage

et al. 2010

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Background-Together with pulmonary veins, many extrapulmonary vein areas may be the source of initiation and maintenance of atrial fibrillation. The left atrial appendage (LAA) is an underestimated site of initiation of atrial fibrillation. Here, we report the prevalence of triggers from the LAA and the best strategy for successful ablation. Methods and Results-Nine hundred eighty-seven consecutive patients (29% paroxysmal, 71% nonparoxysmal) undergoing redo catheter ablation for atrial fibrillation were enrolled. Two hundred sixty-six patients (27%) showed firing from the LAA and became the study population. In 86 of 987 patients (8.7%; 5 paroxysmal, 81 nonparoxysmal), the LAA was found to be the only source of arrhythmia with no pulmonary veins or other extrapulmonary vein site reconnection. Ablation was performed either with focal lesion (nϭ56; group 2) or to achieve LAA isolation by placement of the circular catheter at the ostium of the LAA guided by intracardiac echocardiography (167 patients; group 3). In the remaining patients, LAA firing was not ablated (nϭ43; group 1). At the 12Ϯ3-month follow-up, 32 patients (74%) in group 1 had recurrence compared with 38 (68%) in group 2 and 25 (15%) in group 3 (PϽ0.001). Conclusions-The LAA appears to be responsible for arrhythmias in 27% of patients presenting for repeat procedures.Isolation of the LAA could achieve freedom from atrial fibrillation in patients presenting for a repeat procedure when arrhythmias initiating from this structure are demonstrated. (Circulation. 2010;122:109-118.)

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“…The non-PV ectopic beats may arise from the superior vena cava (SVC), left atrial posterior free wall (LPFW), crista terminalis (CT), coronary sinus ostium (CSO), ligament of Marshall (LOM), and interatrial septum (IAS). [5][6][7][8][9] However, the information about PAF originating from the non-PV area is limited, and the long-term follow-up results of catheter ablation in these patients are not available.…”

mentioning

confidence: 99%

Catheter Ablation of Paroxysmal Atrial Fibrillation Initiated by Non–Pulmonary Vein Ectopy

et al. 2003

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Background-Most of the ectopic beats initiating paroxysmal atrial fibrillation (PAF) originate from the pulmonary vein (PV). However, only limited data are available on PAF originating from the non-PV areas. Methods and Results-Two hundred forty patients with a total of 358 ectopic foci initiating PAF were included.Sixty-eight (28%) patients had AF initiated by ectopic beats (73 foci, 20%) from the non-PV areas, including the left atrial posterior free wall (28, 38.3%), superior vena cava (27, 37.0%), crista terminalis (10, 3.7%), ligament of Marshall (6, 8.2%), coronary sinus ostium (1, 1.4%), and interatrial septum (1, 1.4%). Catheter ablation eliminated AF with acute success rates of 63%, 96%, 100%, 50%, 100%, and 0% in left atrial posterior free wall, superior vena cava, crista terminalis, ligament of Marshall, coronary sinus ostium, and interatrial septum, respectively. During a follow-up period of 22Ϯ11 months, 43 patients (63.2%) were free of antiarrhythmic drugs without AF recurrence. Conclusions-Ectopic

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Identification and Catheter Ablation of Extracardiac and Intracardiac Components of Ligament of Marshall Tissue for Treatment of Paroxysmal Atrial Fibrillation

Abstract: Recording of Marshall potential is feasible in patients with paroxysmal AF. Combined epicardial and endocardial catheter ablation of ligament of Marshall tissue may reduce the paroxysms of adrenergic AF.

Cited by 84 publications

References 14 publications

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

Left Atrial Appendage

Catheter Ablation of Paroxysmal Atrial Fibrillation Initiated by Non–Pulmonary Vein Ectopy

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