A case of successful radiofrequency ablation of an epicardial conduction breakthrough site probably via the septopulmonary bundle – ScienceOpen
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      A case of successful radiofrequency ablation of an epicardial conduction breakthrough site probably via the septopulmonary bundle

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          The architecture of the left lateral atrial wall: a particular anatomic region with implications for ablation of atrial fibrillation.

          We examined the left lateral ridge (LLR) between the orifices of the left pulmonary veins and the left atrial appendage for a better understanding of its structural composition relevant to ablations for atrial fibrillation (AF). The LLR and its surrounding areas were studied in 40 heart specimens by dissection and histological sections. The LLR is a fold of the atrial wall with a mean width that was narrower superiorly than inferiorly (P < 0.001). Its myocardial thickness at the antero-superior level was thicker than at the postero-inferior level (2.8 +/- 1.1 vs. 1.7 +/- 0.8 mm, P < 0.001). Transmurally from subepicardium to subendocardium, the LLR comprises myofibres from the leftward extension of Bachmann's bundle together with the inferior branches of the septopulmonary bundle and the septoatrial bundle. The vein or ligament of Marshall is located on the epicardial aspect of the LLR. The Marshall structures and autonomic nervous system are in close proximity (<3 mm) to the endocardial surface at the superior level of the ridge in 70% of specimens. The variability in width and thickness of the LLR, its proximity to Marshall structures and autonomic nerves, and myofibre arrangement may be significant in the fibrillatory process and spread of AF activity.
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            Risk factors analysis and clinical risk assessment of atrial fibrillation-related stroke

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              The importance of atrial structure and fibers.

              Atrial structures are important in the current era of cardiac interventions using percutaneous transcatheter procedures. Understanding their locations and component parts helps to reduce risks of procedural-related damage. The general arrangement of the myofibers that make up the atrial walls is reviewed to provide a morphologic basis for atrial conduction and potential substrates of arrhythmias. The right atrium, dominated by its appendage, is characterized by having an extensive array of pectinate muscles. These extend almost perpendicularly from the terminal crest. The left atrium has relatively smooth walls and a small tubular-shaped appendage. The myofibers show changes in orientations when traced through the thickness of the walls. Extensions of atrial myocardium onto the pulmonary veins and the superior caval vein are common. Apart from Bachmann's bundle, there are other muscular bridges of variable numbers and sizes that provide interatrial connections, connections between the left atrium and the coronary sinus, and connections between the muscular sleeves of the right pulmonary veins and the right atrium. The purpose of this review is to summarize the three-dimensional arrangement of gross atrial structures, the myoarchitecture and variations in muscular interatrial connections. These are important features in intra- and interatrial conduction. (c) 2008 Wiley-Liss, Inc.
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                Author and article information

                Contributors
                Journal
                HeartRhythm Case Rep
                HeartRhythm Case Rep
                HeartRhythm Case Reports
                Elsevier
                2214-0271
                14 September 2021
                December 2021
                14 September 2021
                : 7
                : 12
                : 825-828
                Affiliations
                [1]Department of Cardiology, Yoshinogawa Medical Center, Yoshinogawa, Japan
                Author notes
                [] Address reprint requests and correspondence: Dr Yasuhiro Yokoyama, Department of Cardiovascular Medicine, Yoshinogawa Medical Center, 120 Chiejima aza Nishichiejima Kamojima-cho, Yoshinogawa, 776-8511, Japan. yshr.yokoyama@ 123456gmail.com
                Article
                S2214-0271(21)00175-5
                10.1016/j.hrcr.2021.09.002
                8695278
                34987968
                0d38af73-6315-4d28-91fd-10d380eabf90
                © 2021 Heart Rhythm Society. Published by Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Categories
                Case Report

                atrial fibrillation,catheter ablation,epicardial conduction,line ablation,septopulmonary bundle

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