Ligament of Marshall

The Ligament of Marshall (LoM) is a complex of muscle bundles, blood vessels, adipose tissue, fibrous structure, ganglia, and nerves between the left atrial appendage and the left superior pulmonary vein. ^{[1] [2]} The LoM consists of the Vein of Marshall (VoM), a band of muscle called to Marshall Bundle (MB), and the epicardial ganglionated plexi. ^[1]

Ligament is fibrous connective tissue between bones, so "ligament" in "Ligament of Marshall" is a misnomer.

Atrial fibrillation

Pulmonary vein isolation has been the mainstay of atrial fibrillation reduction, but in many cases there are other sources of arrhythmia, including the LoM. ^{[1] [3]} Use of ethanol through the VoM has been shown to be an effective way to reduce atrial fibrillation. ^[4]

Discovery

The LoM was discovered in 1850 by John Marshall, which was later named in his honor. ^[1]

References

1. Corradi D, Callegari S, Macchi E (2016). "Morphology and pathophysiology of target anatomical sites for ablation procedures in patients with atrial fibrillation: part II: pulmonary veins, caval veins, ganglionated plexi, and ligament of Marshall". International Journal of Cardiology . 168 (3): 1769–1778. doi:10.1016/j.ijcard.2013.06.141. PMID   23907042.
2. Stavrakis S, Po S (2017). "Ganglionated Plexi Ablation: Physiology and Clinical Applications". Arrhythmia & Electrophysiology Review. 6 (4): 186–190. doi:10.15420/aer2017.26.1. PMC   5739885 . PMID   29326833.
3. Rodríguez-Mañero M, Schurmann P, Valderrábano M (2016). "Ligament and vein of Marshall: A therapeutic opportunity in atrial fibrillation". Heart Rhythm . 13 (2): 593–601. doi:10.1016/j.hrthm.2015.10.018. PMC   4796610 . PMID   26576705.
4. Li F, Sun J, Wang R (2022). "The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis". Frontiers in Cardiovascular Medicine . 9: 871654. doi: 10.3389/fcvm.2022.871654 . PMC   9098965 . PMID   35571170.