Differentiating the ligament of marshall from the pulmonary vein musculature potentials in patients with paroxysmal atrial fibrillation: Electrophysiological characteristics and results of radiofrequency ablation

Ching Tai Tai, Ming Hsiung Hsieh, Chin Feng Tsai, Yung Kuo Lin, Wen Chung Yu, Shih Huang Lee, Yu An Ding, Mau Song Chang, Shin Ann Chen

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

It was reported that paroxysmal atrial fibrillation (PAF) can be initiated by ectopic atrial beats originating from the pulmonary vein (PV) or left atrial tract (LAT) within the ligament of Marshall (LOM). The aim of this study was to differentiate the LAT from the PV potentials, and to investigate the results of radiofrequency ablation guided by these potentials. Ten patients (age 60 ± 12 years) with PAF who had a recording of double potentials (DPs) in or around the left PV were included. Group I had five patients with the second deflection of DPs (D2) due to activation of the LAT, and Group II had five patients with D2 due to activation of the PV musculature. There were no significant difference in the isoelectric interval between DPs, the activation time, and amplitude of D2 between Groups I and II. During distal coronary sinus (CS) pacing, the CS ostium (CSO) to D2 interval was shorter compared with that during sinus rhythm in Group I (39 ± 19 vs 71 ± 25 ms, P = 0.04), but was longer in Group II (96 ± 16 vs 44 ± 19 ms, P = 0.04). During ectopic activation, three patients in Group I, but no Group II patients, had transformation of recorded DPs into triple potentials. Radiofrequency ablation guided by the earliest activation of the LAT potential was performed with transient suppression of PAF, but ablation guided by the earliest activation of the PV potentials had a high success rate in eliminating PAF. In conclusion, differentiating the LAT from the PV potentials for initiation of PAF is feasible by an electrophysiological approach, and may be important for radiofrequency ablation of PAF.

Original languageEnglish
Pages (from-to)1493-1501
Number of pages9
JournalPACE - Pacing and Clinical Electrophysiology
Volume23
Issue number10 I
Publication statusPublished - 2000
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Ligament of Marshall
  • Radiofrequency ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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