To the Editor— Understanding the Complex Anatomy of the Marshall Bundle Might Improve the Ablation Efficacy

Chen et al 1 Chen S. Zhou G. Lu X. et al. The importance of identifying conduction breakthrough sites across the mitral isthmus by elaborate mapping for mitral isthmus linear ablation. Europace. 2019; 21: 950-960 Crossref PubMed Scopus (14) Google Scholar highlight perceived differences in acute and short- and medium-term success rates between their mapping and ablation strategies for creating mitral isthmus (MI) lines 1 Chen S. Zhou G. Lu X. et al. The importance of identifying conduction breakthrough sites across the mitral isthmus by elaborate mapping for mitral isthmus linear ablation. Europace. 2019; 21: 950-960 Crossref PubMed Scopus (14) Google Scholar and our recently reported outcomes of Marshall bundle (MB) reentrant atrial tachycardia (AT) ablation. 2 Vlachos K. Denis A. Takigawa M. et al. The role of Marshall bundle epicardial connections in atrial tachycardias after atrial fibrillation ablation. Heart Rhythm. 2019; 16: 1341-1347 Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar To the Editor— Understanding the complex anatomy of the Marshall bundle might improve the ablation efficacyHeart RhythmVol. 17Issue 4PreviewWe read with great interest the article by Vlachos et al,1 in which they reported that recurrences of Marshall bundle (MB) conduction were mostly observed after radiofrequency ablation (49%) compared with ethanol infusion (11%).1 Undoubtedly, MB, an epicardial structure, is challenging for clinical practice because of its complex anatomy.2 In our previous study,2 with a stepwise approach to elaborately mapping large areas of the lateral left atrium (LA) and/or coronary sinus (CS), MB connections could be successfully eliminated by radiofrequency ablation from the endocardial site and/or within the CS in 59 of 61 patients (96.7%). Full-Text PDF