In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to EHRA Ivory (& above) Members, Fellows of the ESC and Young combined Members

Peri-mitral atrial tachycardia using the marshall bundle epicardial connection

Session Clinical case corner 3

Speaker Kanae Hasegawa

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Arrhythmias, General - Clinical
  • Session type : Poster Session
  • FP Number : P1572

Authors : K Hasegawa (Fukui,JP), S Miyazaki (Fukui,JP), S Miyazaki (Fukui,JP), S Miyazaki (Fukui,JP), K Kaseno (Fukui,JP), K Kaseno (Fukui,JP), K Kaseno (Fukui,JP), H Tada (Fukui,JP), H Tada (Fukui,JP), H Tada (Fukui,JP)


K Hasegawa1 , S Miyazaki1 , S Miyazaki1 , S Miyazaki1 , K Kaseno1 , K Kaseno1 , K Kaseno1 , H Tada1 , H Tada1 , H Tada1 , 1University of Fukui, Cardiology - Fukui - Japan ,


A 89-year-old woman with dilated cardiomyopathy underwent a second ablation procedure for persistent atrial tachycardia (AT) with repeated worsening of heart failure due to the tachycardia.  She had undergone pulmonary vein (PV) isolation by cryoballoon, cavo-tricuspid isthmus, left atrial (LA) roof line, and mitral isthmus linear ablation for symptomatic and drug-resistant persistent atrial fibrillation (AF) in the first procedure 3 months earlier.  The starting rhythm in the second procedure was a stable AT with a tachycardia cycle length of 540 ms.  No PVs reconnected and the block of LA roof and mitral isthmus lines remained.  For detailed analysis of epicardial connection, 2 multipolar catheters were placed at distal and proximal coronary sinus from carotid and femoral veins, respectively.  Moreover, an additional 2 Fr hexapolar catheter (EP star, Japan Life Line, Tokyo, Japan) was inserted into vein of Marshall (VOM).  Activation mapping using high-resolution 3-dimensional mapping system (Rhythmia, Boston Scientific, Natick, Massachusetts) revealed the both endocardial and epicardial conduction block along the mitral isthmus, and peri-mitral AT in which Marshall bundle (MB) epicardial connection bypassed the scar area (Fig A).  Entrainment mapping showed that post-pacing interval from the catheter inside the VOM was equal to the tachycardia cycle length, which further confirmed the diagnosis (Fig A).  A 4.8 seconds of an application at the slow conduction area (the connection between LA ridge and distal MB) terminated the AT (Fig A and B).  Bi-directional conduction block of MB-LA connections were confirmed, and any ATs were not inducible.  No AT recurrence has been observed for 3 months.

Based on your interests

Three reasons why you should become a member

Become a member now
  • 1Access your congress resources all year-round on the New ESC 365
  • 2Get a discount on your next congress registration
  • 3Continue your professional development with free access to educational tools
Become a member now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are