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Atrial Tachycardias Utilizing the Ligament of Marshall Region Following Single Ring Pulmonary Vein Isolation for Atrial Fibrillation.
MedLine Citation:
PMID:  24831656     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Organized atrial tachycardias (OATs) after pulmonary vein isolation (PVI) procedure are common. Arrhythmia mechanisms include mitral annular, ring gap, or roof-dependent gap-related flutters. In this series, we describe a mechanism of arrhythmia utilizing the ridge between left pulmonary vein (PV) and left atrial appendage (LAA) in the Ligament of Marshall (LOM) region.
METHODS AND RESULTS: Five tachycardias involving the LOM region were identified from a group of 240 patients who underwent a single ring PVI procedure for symptomatic atrial fibrillation. The common characteristics of these tachycardias were the endocardial breakout over a broad area adjacent to the LOM region, presence of presystolic or mid-diastolic potentials, and abolition by ablation of the presystolic or mid-diastolic potentials remote from the endocardial breakout site. In all five cases, tachycardias were present after isolation of the veins and posterior left atria. All demonstrated characteristic areas of very slow conduction in the LOM region highlighted by presence of either low voltage, long duration fractionated potentials, or mid-diastolic potentials with a fixed temporal relationship to the subsequent endocardial activation. The pattern of activation and termination of tachycardia during ablation was consistent with an arrhythmia utilizing an electrically insulated tract within LOM and the PV-LAA ridge region.
CONCLUSIONS: We identified a pattern of arrhythmias involving a concealed presystolic component and a broad endocardial breakout site related to the LOM region. Successful ablation site involved careful identification of small diastolic potentials in the LAA/ridge region or adjacent to the coronary sinus.
Authors:
William W B Chik; Jacky Kit Chan; David L Ross; Jackie Wagstaff; Eddy Kizana; Aravinda Thiagalingam; Pramesh Kovoor; Stuart P Thomas
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-5-16
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  -     ISSN:  1540-8159     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-5-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2014 Wiley Periodicals, Inc.
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