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The ligament of Marshall and arrhythmias: A review

Bo He1, Xiaoying Wang1, Fang Zhao1

  • 1Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.

Pacing and Clinical Electrophysiology : PACE
|September 11, 2020
PubMed

Insights

The ligament of Marshall (LOM) contributes to atrial and ventricular arrhythmias due to its complex structure. Therapies targeting the LOM may improve outcomes for advanced atrial fibrillation (AF) and ventricular arrhythmias.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Embryology

Background:

  • The ligament of Marshall (LOM) is an embryonic remnant containing diverse tissues.
  • Its complex structure includes nerves and blood vessels, implicated in cardiac arrhythmias.

Purpose of the Study:

  • To elucidate the structural basis of the LOM's role in atrial and ventricular arrhythmias.
  • To explore LOM-targeted therapies for advanced atrial fibrillation (AF) and ventricular arrhythmias.

Main Methods:

  • Histological and anatomical examination of the LOM.
  • Experimental studies investigating electrophysiological properties.
  • Review of therapeutic interventions targeting the LOM.

Main Results:

  • The LOM's intricate composition facilitates triggers and re-entry circuits for atrial arrhythmias like AF.
  • It acts as a sympathetic conduit, contributing to ventricular arrhythmias.
  • Catheter ablation or ethanol infusion of the LOM shows potential as adjunctive therapy.

Conclusions:

  • The ligament of Marshall is a significant factor in the pathophysiology of both atrial and ventricular arrhythmias.
  • Targeting the LOM offers a promising adjunctive strategy for managing complex cardiac arrhythmias, particularly in advanced AF.

Keywords:
atrial fibrillationethanol ablationligament of Marshallperi-mitral isthmus re-entrant circuitventricular arrhythmias

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