title: Electrophysiological characteristics of the Marshall bundle in humans.
abstract: BACKGROUND
  Marshall bundles (MBs) are the muscle bundles within the ligament of Marshall.
  
  
  OBJECTIVE
  This trial sought to the electrophysiological characteristics of the MB and the anatomical connections between MB and left atrium (LA) in patients with persistent atrial fibrillation (AF).
  
  
  METHODS
  We enrolled 72 patients (male:female 59:13, age 59.9 +/- 9.4 years) who underwent MB mapping and ablation for AF. MB mapping was done via an endocardial or epicardial approach during sinus rhythm and AF.
  
  
  RESULTS
  Recordings were successful in 64 of 72 patients (89%). A single connection was noted in 11 of 64 patients between the MB and the coronary sinus (CS) muscle sleeves. The MB recordings showed distinct MB potentials with a proximal-to-distal activation pattern during sinus rhythm. During AF, organized passive activations and dissociated slow MB ectopic activities were commonly observed in this type of connection. Double connections to both CS and LA around left pulmonary veins were noted in 23 of 64 patients (36%). After the ablation of the distal connection, MB recording showed typical double potentials as in single connection. Multiple connections were noted in 30 of 64 patients (47%). During sinus rhythm, the earliest activation was in the middle of the MB. The activation patterns were irregular and variable in each patient. During AF, rapid and fractionated complex activations were noted in all patients of this group.
  
  
  CONCLUSIONS
  We documented 3 different types of MB-LA connections. Rapid and fractionated activations were most commonly observed in the MB that had multiple LA connections.
authors.affiliation: Department of Medicine, Division of Cardiology, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Seongwook
authors.initials: S
authors.lastname: Han
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.forename: Mauricio
authors.initials: M
authors.lastname: Scanavacca
authors.forename: Eduardo
authors.initials: E
authors.lastname: Sosa
authors.forename: Peng-Sheng
authors.initials: PS
authors.lastname: Chen
authors.forename: Chun
authors.initials: C
authors.lastname: Hwang
mesh_terms: D001281:Atrial Fibrillation / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D018780:Body Surface Potential Mapping; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D004594:Electrophysiology; D004699:Endocardium; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology / Q000473:pathology*; D006329:Heart Conduction System / Q000473:pathology*; D006801:Humans; D007545:Isoproterenol / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D011667:Pulmonary Veins / Q000473:pathology; D012189:Retrospective Studies; D013318:Stroke Volume; D013566:Sympathomimetics / Q000494:pharmacology; D016277:Ventricular Function, Left
chemical_list: D013566:Sympathomimetics; D007545:Isoproterenol