A New Strategy for Mitral Isthmus Line Block:

Marshall Ligament Alcohol Ablation Combined with Radiofrequency Ablation Synergistic Intervention 

二尖瓣峡部线性阻滞的新方法：

Marshall静脉无水乙醇消融联合射频消融

‘2C3L’ as a classic ablation strategy is widely used in persistent CAF. It originated from the classic surgical Cox-maze procedure. Based on PV isolation, further intervention Stagnation line, mitral valve isthmus line, and tricuspid valve isthmus line. Taking additional linear ablation can effectively solve and prevent postoperative atrial flutter. ensure the consistency and effectiveness of the ablation strategy.

“2C3L”作为一种经典的消融方法在持续性持续性房颤（CAF）中得到广泛应用。它起源于经典的外科Cox迷宫术。在肺静脉隔离的基础上，进一步沿左心房顶部线、二尖瓣环峡部线、三尖瓣环峡部线进行电隔离。附加线性消融能有效地解决和预防术后心房扑动，确保消融的效果和稳定性。

However, in the actual operation process, due to its absence of a natural tissue anatomical barrier the mitral valve isthmus is difficult to completely block during the ablation process. At present, our center found that the mitral valve isthmus line is difficult to block because it may have a connection with the epicardium. On this basis, explore the effect of the possible epicardial insertion point of ligament on mitral valve isthmus block.

然而，在实际的手术过程中，由于缺乏先天的组织解剖屏障，二尖瓣峡部在消融过程中很难完全阻断。目前，我们中心发现二尖瓣环峡部线很难实现电隔离，因为它可能与心外膜连接。在此基础上，我们探索了可能的心外膜静脉插入点对二尖瓣峡部阻滞的影响。

The Marshall ligament (LOM) is a bundle of epicardial structures extending from the coronary sinus to the mouth of the left upper pulmonary vein, including the Marshall vein, myocardial cuff, and autonomic nerves. 

Marshall静脉（LOM）是一束从冠状窦延伸至左上肺静脉口的心外膜结构，包括Marshall静脉、心肌袖和自主神经。

Based on the above, we adopt a combination of endocardial and adventitial ablation strategies to intervene in the mitral valve isthmus: on the epicardial surface of the mitral valve isthmus, multiple doses of absolute ethanol (2 mL per time) were used Alcohol ablation was performed on the distal Marshall vein, meanwhile the ablation catheter was used to linearly ablate the endometrial surface. The results of central clinical studies showed that combined ablation can effectively increase the success rate of mitral valve isthmus block and the overall success rate of CAF.

在此基础上，我们对二尖瓣峡部采用心内膜和心外膜联合消融的方法：在二尖瓣峡部心外膜面，对Marshall静脉远端进行多次无水乙醇（2 mL/次）消融，同时用消融导管对心内膜面进行线性消融。中心临床研究结果表明，联合消融可有效提高二尖瓣峡部阻滞的成功率和CAF的总成功率。