Clinical significance of complete conduction block of the left lateral isthmus and its relationship with anatomical variation of the vein of marshall in patients with nonparoxysmal atrial fibrillation

Jongil Choi, Hui Nam Pak, Jae Hyung Park, Eun Jeong Choi, Sook Kyoung Kim, Jae Jin Kwak, Jin Kun Jang, Chun Hwang, Young Hoon Kim

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: The vein of Marshall (VOM), which exists along the left lateral isthmus (LLI), constitutes a muscular connection between the coronary sinus (CS) and the left atrium (LA). We hypothesized that anatomical variation of the VOM affects the bidirectional block of LLI and the clinical outcome in patients with nonparoxysmal atrial fibrillation (NPAF). Methods: Among 73 patients with NPAF, 54 patients (47 male, 54.1 ± 10.4 years old) with a clearly visible VOM (74.0%) were included. After circumferential antral ablation, double linear endocardial ablation of LLI was performed along the VOM. Unless LLI block was achievable by endocardial ablation, the ablation was performed inside the CS. Results: LLI block was achievable in 35 patients (64.8%; 11.1% by endocardial ablation vs 53.7% by additional inside CS ablation; P < 0.01). In patients with failed LLI block, the VOM was significantly longer (P < 0.05) on the right anterior oblique (RAO) view than in those with successful LLI block. LA volume or LLI length measured by CT image were not different (P = NS). During 11.4 ± 5.0 months follow-up, early recurrences within 3 months (47.4% vs 28.6%, P = NS) and recurrences after 3 months (10.5% vs 17.7%, P = NS) were not different with or without LLI block. Conclusion: LLI block, which is more difficult to achieve in patients with a longer VOM, was achievable in 65% of patients with NPAF by linear ablation along the VOM and additional inside CS ablation, but did not affect the short-term clinical outcome.

Original languageEnglish
Pages (from-to)616-622
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number6
DOIs
Publication statusPublished - 2009 Jun 1

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Atrial Fibrillation
Veins
Coronary Sinus
Heart Atria
Recurrence
carbosulfan

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Left lateral isthmus
  • Vein of Marshall

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Clinical significance of complete conduction block of the left lateral isthmus and its relationship with anatomical variation of the vein of marshall in patients with nonparoxysmal atrial fibrillation. / Choi, Jongil; Pak, Hui Nam; Park, Jae Hyung; Choi, Eun Jeong; Kim, Sook Kyoung; Kwak, Jae Jin; Jang, Jin Kun; Hwang, Chun; Kim, Young Hoon.

In: Journal of Cardiovascular Electrophysiology, Vol. 20, No. 6, 01.06.2009, p. 616-622.

Research output: Contribution to journalArticle

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abstract = "Background: The vein of Marshall (VOM), which exists along the left lateral isthmus (LLI), constitutes a muscular connection between the coronary sinus (CS) and the left atrium (LA). We hypothesized that anatomical variation of the VOM affects the bidirectional block of LLI and the clinical outcome in patients with nonparoxysmal atrial fibrillation (NPAF). Methods: Among 73 patients with NPAF, 54 patients (47 male, 54.1 ± 10.4 years old) with a clearly visible VOM (74.0{\%}) were included. After circumferential antral ablation, double linear endocardial ablation of LLI was performed along the VOM. Unless LLI block was achievable by endocardial ablation, the ablation was performed inside the CS. Results: LLI block was achievable in 35 patients (64.8{\%}; 11.1{\%} by endocardial ablation vs 53.7{\%} by additional inside CS ablation; P < 0.01). In patients with failed LLI block, the VOM was significantly longer (P < 0.05) on the right anterior oblique (RAO) view than in those with successful LLI block. LA volume or LLI length measured by CT image were not different (P = NS). During 11.4 ± 5.0 months follow-up, early recurrences within 3 months (47.4{\%} vs 28.6{\%}, P = NS) and recurrences after 3 months (10.5{\%} vs 17.7{\%}, P = NS) were not different with or without LLI block. Conclusion: LLI block, which is more difficult to achieve in patients with a longer VOM, was achievable in 65{\%} of patients with NPAF by linear ablation along the VOM and additional inside CS ablation, but did not affect the short-term clinical outcome.",
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T1 - Clinical significance of complete conduction block of the left lateral isthmus and its relationship with anatomical variation of the vein of marshall in patients with nonparoxysmal atrial fibrillation

AU - Choi, Jongil

AU - Pak, Hui Nam

AU - Park, Jae Hyung

AU - Choi, Eun Jeong

AU - Kim, Sook Kyoung

AU - Kwak, Jae Jin

AU - Jang, Jin Kun

AU - Hwang, Chun

AU - Kim, Young Hoon

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N2 - Background: The vein of Marshall (VOM), which exists along the left lateral isthmus (LLI), constitutes a muscular connection between the coronary sinus (CS) and the left atrium (LA). We hypothesized that anatomical variation of the VOM affects the bidirectional block of LLI and the clinical outcome in patients with nonparoxysmal atrial fibrillation (NPAF). Methods: Among 73 patients with NPAF, 54 patients (47 male, 54.1 ± 10.4 years old) with a clearly visible VOM (74.0%) were included. After circumferential antral ablation, double linear endocardial ablation of LLI was performed along the VOM. Unless LLI block was achievable by endocardial ablation, the ablation was performed inside the CS. Results: LLI block was achievable in 35 patients (64.8%; 11.1% by endocardial ablation vs 53.7% by additional inside CS ablation; P < 0.01). In patients with failed LLI block, the VOM was significantly longer (P < 0.05) on the right anterior oblique (RAO) view than in those with successful LLI block. LA volume or LLI length measured by CT image were not different (P = NS). During 11.4 ± 5.0 months follow-up, early recurrences within 3 months (47.4% vs 28.6%, P = NS) and recurrences after 3 months (10.5% vs 17.7%, P = NS) were not different with or without LLI block. Conclusion: LLI block, which is more difficult to achieve in patients with a longer VOM, was achievable in 65% of patients with NPAF by linear ablation along the VOM and additional inside CS ablation, but did not affect the short-term clinical outcome.

AB - Background: The vein of Marshall (VOM), which exists along the left lateral isthmus (LLI), constitutes a muscular connection between the coronary sinus (CS) and the left atrium (LA). We hypothesized that anatomical variation of the VOM affects the bidirectional block of LLI and the clinical outcome in patients with nonparoxysmal atrial fibrillation (NPAF). Methods: Among 73 patients with NPAF, 54 patients (47 male, 54.1 ± 10.4 years old) with a clearly visible VOM (74.0%) were included. After circumferential antral ablation, double linear endocardial ablation of LLI was performed along the VOM. Unless LLI block was achievable by endocardial ablation, the ablation was performed inside the CS. Results: LLI block was achievable in 35 patients (64.8%; 11.1% by endocardial ablation vs 53.7% by additional inside CS ablation; P < 0.01). In patients with failed LLI block, the VOM was significantly longer (P < 0.05) on the right anterior oblique (RAO) view than in those with successful LLI block. LA volume or LLI length measured by CT image were not different (P = NS). During 11.4 ± 5.0 months follow-up, early recurrences within 3 months (47.4% vs 28.6%, P = NS) and recurrences after 3 months (10.5% vs 17.7%, P = NS) were not different with or without LLI block. Conclusion: LLI block, which is more difficult to achieve in patients with a longer VOM, was achievable in 65% of patients with NPAF by linear ablation along the VOM and additional inside CS ablation, but did not affect the short-term clinical outcome.

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KW - Catheter ablation

KW - Left lateral isthmus

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