Miguel Valderrábano, MD Heart Rhythm

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Ligament of Marshall arrhythmogenesis and vein of Marshall ethanol: A problem with a solution Miguel Valderrábano, MD Heart Rhythm Volume 15, Issue 1, Pages 25-27 (January 2018) DOI: 10.1016/j.hrthm.2017.09.013 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Ligament and vein of Marshall (LOM/VOM) arrhythmogenesis. A: Schematic of the VOM arrhythmogenic mechanisms: (1) sympathetic and parasympathetic innervation, which can generate a profibrillatory substrate and ectopic beats; (2) myocardial bundles, which can lead to epicardial connections with the pulmonary veins (PVs) and atrial tissue and can bypass ablation lesions created in the mitral isthmus (shaded gray area). B: Histology of the coronary sinus (CS) and VOM takeoff, showing the CS myocardial sleeve ending at the valve of Vieussens (VV) and the great cardiac vein (GCV) without myocardial sleeve. C: Sympathetic innervation (tyrosine hydroxylase staining, arrow) and adjacent myocardial tract in the LOM. D: Parasympathetic innervation bundles (acetylcholinesterase staining) adjacent to the VOM. E: Myocardial connections (arrow) between the LOM and the atrial myocardium. LA = left atrium. Heart Rhythm 2018 15, 25-27DOI: (10.1016/j.hrthm.2017.09.013) Copyright © 2017 Heart Rhythm Society Terms and Conditions