Identification and Endocardial Ablation of the Ligament of Marshall for Pulmonary Vein Isolation
| Autor: | Andreas Kalogeropoulos, Ibrahim Almasry, Abhijeet Singh, Roger Fan, Eric Rashba, Jennifer Chee |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Radiofrequency ablation medicine.medical_treatment 030204 cardiovascular system & hematology Pulmonary vein law.invention 03 medical and health sciences 0302 clinical medicine law Atrial Fibrillation Left superior pulmonary vein medicine Humans In patient 030212 general & internal medicine Ligaments business.industry Atrial fibrillation medicine.disease Ablation medicine.anatomical_structure Pulmonary Veins Catheter Ablation Ligament Radiology business Left Pulmonary Vein Endocardium |
| Zdroj: | JACC: Clinical Electrophysiology. 7:283-291 |
| ISSN: | 2405-500X |
| Popis: | Objectives The aims of this study were to establish criteria for identifying ligament of Marshall (LOM) connections that are responsible for pulmonary vein isolation (PVI) failure, assess their incidence, and determine if they can be targeted by focal endocardial ablation at the anterior carina of the left superior pulmonary vein (LSPV). Background Wide antral ablation of the left pulmonary veins (PVs) may not achieve PVI, sometimes requiring empirical ablation of the PV carina. The mechanism could be due to epicardial conduction along the LOM, which courses adjacent to the anterior carina. Methods In patients undergoing radiofrequency ablation for atrial fibrillation, if wide ablation of the left PV did not achieve isolation, bidirectional mapping was performed. A presumptive LOM connection was diagnosed if the earliest entrance was mapped to the anterior LSPV, while the earliest exit was mapped inferior to the left inferior PV. Focal ablation at the LSPV anterior carina was performed, even if not at the site of earliest entrance activation. The primary endpoint was successful PVI immediately after ablation. Results The study included 455 consecutive patients who underwent 570 procedures, of which 364 were first-time ablations. Presumptive LOM connections were identified in 48 procedures (8.4%) and in 41 patients (11.2%) undergoing first-time ablation and were successfully ablated at the anterior carina of the LSPV in 47 of 48 procedures (98%). Conclusions LOM connections may be a common cause of PVI failure and can be easily identified and reliably ablated with focal endocardial ablation at the anterior LSPV carina. |
| Databáze: | OpenAIRE |
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