Skip to main content
Top
Published in: Heart and Vessels 3/2015

01-05-2015 | Case Report

Hybrid epicardial and endocardial ablation of a persistent atrial tachycardia arising from the marshall bundle: the importance of a detailed analysis of the local potentials

Authors: Kenji Kuroki, Hiroshi Tada, Fusanori Kunugida, Yukio Sekiguchi, Takeshi Machino, Hiro Yamasaki, Miyako Igarashi, Kazutaka Aonuma

Published in: Heart and Vessels | Issue 3/2015

Login to get access

Abstract

Radiofrequency catheter ablation of an atrial tachycardia (AT) and atrial fibrillation (AF) was performed in a patient with a history of pulmonary vein isolation for paroxysmal AF. The AT exhibited a centrifugal pattern with the posterolateral LA as the earliest activation site. The AT was not terminated by ablation at the endocardial earliest site, but its cycle length was prolonged by ablation at an opposite site within the Vein of Marshall. Finally, the AT was terminated by an energy application at a site 7 mm posteroinferior to the initial earliest activation site. We analyzed the local potentials of each energy delivery site in detail.
Literature
1.
go back to reference Polymeropoulos KP, Rodriguez LM, Timmermans C, Wellens HJ (2002) Images in cardiovascular medicine. Radiofrequency ablation of a focal atrial tachycardia originating from the Marshall ligament as a trigger for atrial fibrillation. Circulation 105:2112–2113CrossRefPubMed Polymeropoulos KP, Rodriguez LM, Timmermans C, Wellens HJ (2002) Images in cardiovascular medicine. Radiofrequency ablation of a focal atrial tachycardia originating from the Marshall ligament as a trigger for atrial fibrillation. Circulation 105:2112–2113CrossRefPubMed
2.
go back to reference Pak HN, Hwang C, Lim HE, Kim JS, Kim YH (2007) Hybrid epicardial and endocardial ablation of persistent or permanent atrial fibrillation: a new approach for difficult cases. J Cardiovasc Electrophysiol 18:917–923CrossRefPubMed Pak HN, Hwang C, Lim HE, Kim JS, Kim YH (2007) Hybrid epicardial and endocardial ablation of persistent or permanent atrial fibrillation: a new approach for difficult cases. J Cardiovasc Electrophysiol 18:917–923CrossRefPubMed
3.
go back to reference Knecht S, Jais P, Lim KT, Veenhuyzen GD, Matsuo S, Haissaguerre M (2007) Slow conduction of the vein of Marshall in the context of permanent atrial fibrillation ablation. J Cardiovasc Electrophysiol 18:1004–1005CrossRefPubMed Knecht S, Jais P, Lim KT, Veenhuyzen GD, Matsuo S, Haissaguerre M (2007) Slow conduction of the vein of Marshall in the context of permanent atrial fibrillation ablation. J Cardiovasc Electrophysiol 18:1004–1005CrossRefPubMed
4.
go back to reference Hwang C, Fishbein MC, Chen PS (2006) How and when to ablate the ligament of Marshall. Heart Rhythm 3:1505–1507CrossRefPubMed Hwang C, Fishbein MC, Chen PS (2006) How and when to ablate the ligament of Marshall. Heart Rhythm 3:1505–1507CrossRefPubMed
5.
go back to reference Hioki M, Matsuo S, Yamane T, Tokutake K, Ito K, Narui R, Tanigawa S, Yamashita S, Tokuda M, Inada K, Date T, Yoshimura M (2012) Adenosine-induced atrial tachycardia and multiple foci initiating atrial fibrillation eliminated by catheter ablation using a non-contact mapping system. Heart Vessels 27:221–226CrossRefPubMed Hioki M, Matsuo S, Yamane T, Tokutake K, Ito K, Narui R, Tanigawa S, Yamashita S, Tokuda M, Inada K, Date T, Yoshimura M (2012) Adenosine-induced atrial tachycardia and multiple foci initiating atrial fibrillation eliminated by catheter ablation using a non-contact mapping system. Heart Vessels 27:221–226CrossRefPubMed
6.
go back to reference Maeda S, Iesaka Y, Uno K, Otomo K, Nagata Y, Suzuki K, Hachiya H, Goya M, Takahashi A, Fujiwara H, Hiraoka M, Isobe M (2012) Complex anatomy surrounding the left atrial posterior wall: analysis with 3D computed tomography. Heart Vessels 27:58–64CrossRefPubMed Maeda S, Iesaka Y, Uno K, Otomo K, Nagata Y, Suzuki K, Hachiya H, Goya M, Takahashi A, Fujiwara H, Hiraoka M, Isobe M (2012) Complex anatomy surrounding the left atrial posterior wall: analysis with 3D computed tomography. Heart Vessels 27:58–64CrossRefPubMed
Metadata
Title
Hybrid epicardial and endocardial ablation of a persistent atrial tachycardia arising from the marshall bundle: the importance of a detailed analysis of the local potentials
Authors
Kenji Kuroki
Hiroshi Tada
Fusanori Kunugida
Yukio Sekiguchi
Takeshi Machino
Hiro Yamasaki
Miyako Igarashi
Kazutaka Aonuma
Publication date
01-05-2015
Publisher
Springer Japan
Published in
Heart and Vessels / Issue 3/2015
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-014-0498-3

Other articles of this Issue 3/2015

Heart and Vessels 3/2015 Go to the issue