The ligament of Marshall and arrhythmias: A review

The ligament of Marshall (LOM) is a remnant of the embryonic sinus venosus and left cardinal vein and contains fat and fibrous tissues, blood vessels, muscle bundles, nerve fibers and ganglia. The complexity of LOM's structure makes it as a source of triggers and drivers as well as substrates of reentry for atrial arrhythmias, especially for atrial fibrillation (AF). LOM also serves as a portion of left atrial macro-reentrant circuit, especially peri-mitral isthmus reentrant circuit. Experimental studies demonstrate that the LOM acts as a sympathetic conduit between the left stellate ganglion and the ventricles and participates in the initiation and maintenance of ventricular arrhythmias. Endocardial or epicardial catheter ablation or ethanol infusion into the vein of Marshall may serve as an important adjunct therapy to pulmonary vein isolation in patients with advanced stage of AF and may help alleviate ventricular arrhythmias as well. This article is protected by copyright. All rights reserved.