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Published on: July 20, 2022
Vein of Marshall activity during sustained atrial fibrillation
Santosh Kamanu1, Alex Y Tan, C Thomas Peter
1Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center and the David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
Insights
The vein of Marshall (VOM) shows rapid, fragmented electrical activation during persistent atrial fibrillation (AF). Ablating the VOM can terminate AF, suggesting its role in the arrhythmia.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Anatomy
Background:
- The vein of Marshall (VOM) activation patterns in sustained atrial fibrillation (AF) remain understudied.
- Understanding VOM's role is crucial for novel AF treatment strategies.
Purpose of the Study:
- To investigate the electrophysiological characteristics of the vein of Marshall (VOM) during persistent and permanent atrial fibrillation (AF).
- To determine if VOM activation patterns contribute to the maintenance of AF.
Main Methods:
- Cannulation of the VOM via the coronary sinus in six patients with persistent or permanent AF undergoing radiofrequency catheter ablation.
- Recording of VOM activation patterns and comparison with other atrial sites during sinus rhythm and AF.
Main Results:
- Frequent, fragmented ectopic beats originating from the VOM were observed in patients with persistent AF.
- During AF, the VOM exhibited significantly shorter activation cycle lengths and higher dominant frequencies compared to other atrial sites.
- Radiofrequency ablation of the VOM led to AF termination in one patient.
Conclusions:
- The vein of Marshall (VOM) is a common source of complex, rapid ectopic activity in patients with sustained AF.
- Rapid VOM activation during AF suggests its significant contribution to the arrhythmia.
- VOM ablation may be a potential therapeutic strategy for specific AF subtypes.
Background:
The human vein of Marshall (VOM) activation patterns during sustained (persistent or permanent) atrial fibrillation (AF) have not been studied in detail.
Methods:
VOM was cannulated via coronary sinus in six patients (67.3 +/- 7.5 years old) having either persistent (N = 4) or permanent (N = 2) AF presenting for radiofrequency catheter ablation.
Results:
At sinus rhythm in patients with persistent AF, there were frequent ectopic beats from the VOM as well as from left and right pulmonary veins (PVs). The ectopic activity originating from the VOM was highly fragmented. The P wave morphology associated with VOM ectopy was isoelectric in leads I and aVL, positive in leads II, III, aVF, and V2-V5, which is similar to the P wave morphology associated with left PV ectopic beats. During AF the activation cycle length at VOM was 140 +/- 31 msec, which was significantly shorter than that in other atrial sites (P < 0.05). Similarly, the dominant frequency at VOM (9.71 Hz +/- 1.52 Hz) was significantly higher than that at other atrial sites (P < 0.0001). In one patient, VOM ablation was associated with AF termination during radiofrequency energy application.
Conclusions:
Ectopic activity with complex local electrogram originating from VOM is commonly seen in patients with sustained AF. The P wave morphology associated with the ectopic beats from VOM and from the left PVs was similar. The rate of activation at VOM is significantly faster than other atrial and PV sites during AF. These findings show that rapid activation is present in the VOM during sustained AF in human patients.
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