Invasive electrophysiology The vein of Marshall as a source of various types of atrial arrhythmias, including adrenergic paroxysmal atrial fibrillation – successful catheter ablation

Abstract

We describe a case of a 44-year old man with recurrent atrial arrhythmias (atrial ectopy, atrial tachycardia and fibrillation) originating from the vein of Marshall (VoM). Stress, exertion and isoproterenol increased frequency and duration of highly symptomatic arrhythmia paroxysms. In 2002 he underwent two sessions of RF ablation. In the area of the left inferior pulmonary vein ostium (LIPV) and along the course the VoM, spiky, firing potentials were recorded. Ablation of the VoM region induced high frequency focal firing (CL~200 ms) with 1: 1 VoM ® LA conduction. Before sinus rhythm return, a gradual increase of conduction of VoM ® LA block was observed. During the second session residual breakthroughs were recorded. During 5 years of follow-up the patient remained free from arrhythmia without antiarrhythmic drugs.