russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2025-6594GXYSWErussjcardiol-6594Research ArticleФИБРИЛЛЯЦИЯ ПРЕДСЕРДИЙATRIAL FIBRILLATIONСвязка Маршалла и ее роль в нарушениях ритма сердца (обзор)Role of the ligament of Marshall in arrhythmogenesis: a reviewhttps://orcid.org/0000-0002-3878-8783ГасымоваН. З.GasimovaN. Z.

Гасымова Нигар Закарьевна — к.м.н., с.н.с. НИЛ нейромодуляцииул. Аккуратова, д. 2, Санкт-Петербург, 197341

Akkuratova str., 2, St. Petersburg, 197341

nigarzakariyya@gmail.comhttps://orcid.org/0000-0001-7185-0983КоробченкоЛ. Е.KorobchenkoL. E.

Коробченко Лев Евгеньевич — м.н.с. НИЛ нейромодуляцииул. Аккуратова, д. 2, Санкт-Петербург, 197341

Akkuratova str., 2, St. Petersburg, 197341

lev.korobchenko@gmail.comСтариковаА. В.StarikovaA. V.

Старикова Алла Витальевна — ординатор по специальности сердечно-­сосудистая хирургияул. Аккуратова, д. 2, Санкт-Петербург, 197341

Akkuratova str., 2, St. Petersburg, 197341

allochkastarikova@mail.ruhttps://orcid.org/0000-0003-3915-5782Исмаил-задеИ. К.Ismail-zadeI. K.

Исмаил-заде Имран Курбанович — к.м.н., сердечно-­сосудистый хирургул. Аккуратова, д. 2, Санкт-Петербург, 197341

Akkuratova str., 2, St. Petersburg, 197341

ismailzade_ik@almazovcentre.ruИвановИ. Ю.IvanovI. Yu.

Сердечно-­сосудистый хирург, отделение сердечно-­сосудистой хирургии 3ул. Аккуратова, д. 2, Санкт-Петербург, 197341

Akkuratova str., 2, St. Petersburg, 197341

https://orcid.org/0000-0003-0735-7822МитрофановаЛ. Б.MitrofanovaL. B.

Митрофанова Любовь Борисовна — д.м.н., профессор, зав. НИЛ патоморфологии

ул. Аккуратова, д. 2, Санкт-Петербург, 197341

Akkuratova str., 2, St. Petersburg, 197341

lubamitr@yandex.ruhttps://orcid.org/0000-0002-6553-9141МихайловЕ. Н.MikhailovE. N.

Михайлов Евгений Николаевич — д.м.н., профессор, декан факультета последипломного образования

ул. Аккуратова, д. 2, Санкт-Петербург, 197341

Akkuratova str., 2, St. Petersburg, 197341

evgenymikhaylov@gmail.comФГБУ Национальный медицинский исследовательский центр им. В. А. Алмазова Минздрава РоссииРоссияAlmazov National Medical Research CenterRussian Federation202522032026304SОбразование65946594Copyright © Гасымова Н.З., Коробченко Л.Е., Старикова А.В., Исмаил-заде И.К., Иванов И.Ю., Митрофанова Л.Б., Михайлов Е.Н., 20262026Гасымова Н.З., Коробченко Л.Е., Старикова А.В., Исмаил-заде И.К., Иванов И.Ю., Митрофанова Л.Б., Михайлов Е.Н.Gasimova N.Z., Korobchenko L.E., Starikova A.V., Ismail-zade I.K., Ivanov I.Y., Mitrofanova L.B., Mikhailov E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/6594

Связка Маршалла, являясь рудиментарной структурой, играет ключевую роль в аритмогенезе из-за сочетания сохранившихся в ней мышечных волокон с патологическим автоматизмом и плотной вегетативной иннервации. Её элиминация приводит к увеличению эффективности интервенционного лечения персистирующей фибрилляции предсердий, а также профилактирует развитие послеоперационной фибрилляции предсердий и желудочковых аритмий.

The ligament of Marshall as a vestigial structure plays a key role in arrhythmogenesis due to the combination of preserved muscle fibers with abnormal automaticity and dense autonomic innervation. Its elimination leads to an increase in the effectiveness of interventional treatment of persistent atrial fibrillation and also prevents postoperative atrial fibrillation and ventricular arrhythmias.

связка Маршаллааритмогенезморфофункциональная характеристикаметоды исследованияклиническое значениефибрилляция предсердийрадиочастотная аблацияспиртовая аблацияligament of Marshallarrhythmogenesismorphofunctional characteristicsresearch methodsclinical significanceatrial fibrillationradiofrequency ablationalcohol ablationReferencesMarshall J. On the development of the great anterior veins in man and mammalia: including an account of certain remnants of foetal structure found in the adult, a comparative view of these great veins in the different mammalia, and an analysis of their occasional peculiarities in the human subject. Phil Trans R Soc Lond. 1850;140:133-69.Marshall J. On the development of the great anterior veins in man and mammalia: including an account of certain remnants of foetal structure found in the adult, a comparative view of these great veins in the different mammalia, and an analysis of their occasional peculiarities in the human subject. Phil Trans R Soc Lond. 1850;140:133-69.Scherlag BJ, Yeh BK, Robinson MJ. Inferior interatrial pathway in the dog. Circ Res. 1972;31:18-35. doi:10.1161/01.res.31.1.18.Scherlag BJ, Yeh BK, Robinson MJ. Inferior interatrial pathway in the dog. Circ Res. 1972;31:18-35. doi:10.1161/01.res.31.1.18.Kim DT, Lai AC, Hwang C, et al. The ligament of Marshall: a structural analysis in human hearts with implications for atrial arrhythmias. J Am Coll Cardiol. 2000;36(4):1324-7. doi:10.1016/s0735-1097(00)00819-6.Kim DT, Lai AC, Hwang C, et al. The ligament of Marshall: a structural analysis in human hearts with implications for atrial arrhythmias. J Am Coll Cardiol. 2000;36(4):1324-7. doi:10.1016/s0735-1097(00)00819-6.He B, Wang X, Zhao F, et al. The ligament of Marshall and arrhythmias: A review. Pacing Clin Electrophysiol. 2021;44(5):792-9. doi:10.1111/pace.14071.He B, Wang X, Zhao F, et al. The ligament of Marshall and arrhythmias: A review. Pacing Clin Electrophysiol. 2021;44(5):792-9. doi:10.1111/pace.14071.Chandra R, Ehab J, Nagaraj M, et al. The Ligament of Marshall: Far From Vestigial! Ann Thorac Surg Short Rep. 2024;3(1):253-7. doi:10.1016/j.atssr.2024.09.001.Chandra R, Ehab J, Nagaraj M, et al. The Ligament of Marshall: Far From Vestigial! Ann Thorac Surg Short Rep. 2024;3(1):253-7. doi:10.1016/j.atssr.2024.09.001.Ulphani JS, Arora R, Cain JH, et al. The ligament of Marshall as a parasympathetic conduit. Am J Physiol Heart Circ Physiol. 2007;293(3):1629-35. doi:10.1152/ajpheart.00139.2007.Ulphani JS, Arora R, Cain JH, et al. The ligament of Marshall as a parasympathetic conduit. Am J Physiol Heart Circ Physiol. 2007;293(3):1629-35. doi:10.1152/ajpheart.00139.2007.Артеменко С.Н., Романов А.Б., Шабанов В.В. и др. Радиочастотная аблация ганглионарных сплетений и зон сложных фракционированных предсердных электрограмм у пациентов с фибрилляцией предсердий. Вестник аритмологии. 2013;(71):12-8.Artemenko SN, Romanov AB, Shabanov VV, et al. Radiofrequency ablation of ganglion plexuses and areas of complex fractionated atrial electrograms in patients with atrial fibrillation. Journal of Arrhythmology. 2013;(71):12-8. (In Russ.)Scherlag BJ. The ligament of Marshall: A historical perspective. Heart Rhythm. 2021;18(7): 1088-9. doi:10.1016/j.hrthm.2021.04.029.Scherlag BJ. The ligament of Marshall: A historical perspective. Heart Rhythm. 2021;18(7): 1088-9. doi:10.1016/j.hrthm.2021.04.029.Liu S, Yu X, Luo D, et al. Ablation of the Ligament of Marshall and Left Stellate Ganglion Similarly Reduces Ventricular Arrhythmias During Acute Myocardial Infarction. Circ Arrhythm Electrophysiol. 2018;11(5):e005945. doi:10.1161/CIRCEP.117.005945.Liu S, Yu X, Luo D, et al. Ablation of the Ligament of Marshall and Left Stellate Ganglion Similarly Reduces Ventricular Arrhythmias During Acute Myocardial Infarction. Circ Arrhythm Electrophysiol. 2018;11(5):e005945. doi:10.1161/CIRCEP.117.005945.Ito M, Arita M, Saeki K, et al. Functional properties of sinocaval conduction. Jpn J Physiol. 1967;17:174-89. doi:10.2170/jjphysiol.17.174.Ito M, Arita M, Saeki K, et al. Functional properties of sinocaval conduction. Jpn J Physiol. 1967;17:174-89. doi:10.2170/jjphysiol.17.174.Takigawa M, Martin C, Jaïs P. Mechanisms of Vein of Marshall-related tachyarrhythmias and the impact of ethanol infusion. Rev Cardiovasc Med. 2024;25(4):112. doi:10.31083/j.rcm2504112.Takigawa M, Martin C, Jaïs P. Mechanisms of Vein of Marshall-related tachyarrhythmias and the impact of ethanol infusion. Rev Cardiovasc Med. 2024;25(4):112. doi:10.31083/j.rcm2504112.Makino M, Inoue S, Matsuyama TA, et al. Diverse myocardial extension and autonomic innervation on ligament of Marshall in humans. J Cardiovasc Electrophysiol. 2006;17:594- 9. doi:10.1111/j.1540-8167.2006.00375.x.Makino M, Inoue S, Matsuyama TA, et al. Diverse myocardial extension and autonomic innervation on ligament of Marshall in humans. J Cardiovasc Electrophysiol. 2006;17:594- 9. doi:10.1111/j.1540-8167.2006.00375.x.Polymeropoulos KP, Rodriguez LM, Timmermans C, et al. Images in cardiovascular medicine. Radiofrequency ablation of a focal atrial tachycardia originating from the Marshall ligament as a trigger for atrial fibrillation. Circulation. 2002;105(17):2112-3. doi:10.1161/01.cir.0000016168.49833.ce.Polymeropoulos KP, Rodriguez LM, Timmermans C, et al. Images in cardiovascular medicine. Radiofrequency ablation of a focal atrial tachycardia originating from the Marshall ligament as a trigger for atrial fibrillation. Circulation. 2002;105(17):2112-3. doi:10.1161/01.cir.0000016168.49833.ce.Rodríguez-Mañero M, Schurmann P, Valderrábano M. Ligament and vein of Marshall: a therapeutic opportunity in atrial fibrillation. Heart Rhythm. 2016;13:593-601. doi:10.1016/j.hrthm.2015.10.018.Rodríguez-Mañero M, Schurmann P, Valderrábano M. Ligament and vein of Marshall: a therapeutic opportunity in atrial fibrillation. Heart Rhythm. 2016;13:593-601. doi:10.1016/j.hrthm.2015.10.018.Канорский С.Г., Полищук Л.В. Стратегия контроля ритма при фибрилляции предсердий: современное состояние проблемы. Вестник аритмологии. 2024;31(2):e5 e14. doi:10.35336/VA-1335.Kanorskii SG, Polischuk LV. Rhythm control strategy in atrial fibrillation: state of the art. Journal of Arrhythmology. 2024;31(2):e5 e14. (In Russ.) doi:10.35336/VA-1335.Александрова И.С., Чапурных А.В. Фокальная активность в генезе фибрилляции предсердий: современное состояние проблемы. Вестник аритмологии. 2023;30(2):е12 е26. doi:10.35336/VA-2023-2-12.Aleksandrova IS, Chapurnykh AV. Focal activity in atrial fibrillation: state of the art. Journal of Arrhythmology. 2023;30(2):е12 е26. (In Russ.) doi:10.35336/VA-2023-2-12.Lin J, Scherlag BJ, Niu G, et al. Autonomic elements within the ligament of Marshall and inferior left ganglionated plexus mediate functions of the atrial neural network. J Cardiovasc Electrophysiol. 2009;20(3):318-24. doi:10.1111/j.1540-8167.2008.01315.x.Lin J, Scherlag BJ, Niu G, et al. Autonomic elements within the ligament of Marshall and inferior left ganglionated plexus mediate functions of the atrial neural network. J Cardiovasc Electrophysiol. 2009;20(3):318-24. doi:10.1111/j.1540-8167.2008.01315.x.Lin J, Scherlag BJ, Lu Z, et al. Inducibility of atrial and ventricular arrhythmias along the ligament of Marshall: role of autonomic factors. J Cardiovasc Electrophysiol. 2008;19:955- 62. doi:10.1111/j.1540-8167.2008.01159.x.Lin J, Scherlag BJ, Lu Z, et al. Inducibility of atrial and ventricular arrhythmias along the ligament of Marshall: role of autonomic factors. J Cardiovasc Electrophysiol. 2008;19:955- 62. doi:10.1111/j.1540-8167.2008.01159.x.Patterson E, Lazzara R, Szabo B, et al. Sodium-calcium exchange initiated by the Ca2+ transient: an arrhythmia trigger within pulmonary veins. J Am Coll Cardiol. 2006;47(6):1196- 206. doi:10.1016/j.jacc.2005.12.023.Patterson E, Lazzara R, Szabo B, et al. Sodium-calcium exchange initiated by the Ca2+ transient: an arrhythmia trigger within pulmonary veins. J Am Coll Cardiol. 2006;47(6):1196- 206. doi:10.1016/j.jacc.2005.12.023.Kamanu S, Tan AY, Peter CT, et al. Vein of Marshall activity during sustained atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17(8):839-46. doi:10.1111/j.1540-8167.2006.00516.x.Kamanu S, Tan AY, Peter CT, et al. Vein of Marshall activity during sustained atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17(8):839-46. doi:10.1111/j.1540-8167.2006.00516.x.Scherlag BJ, Nakagawa H, Jackman WM, et al. Electrical stimulation to identify neural elements on the heart: their role in atrial fibrillation. J Interv Card Electrophysiol. 2005;13 Suppl 1:37-42. doi:10.1007/s10840-005-2492-2. 2Scherlag BJ, Nakagawa H, Jackman WM, et al. Electrical stimulation to identify neural elements on the heart: their role in atrial fibrillation. J Interv Card Electrophysiol. 2005;13 Suppl 1:37-42. doi:10.1007/s10840-005-2492-2. 2Aidonidis I, Poyatzi A, Stamatiou G, et al. Assessment of local atrial repolarization in a porcine acetylcholine model of atrial flutter and fibrillation. Acta Cardiol. 2009;64(1):59-64. doi:10.2143/AC.64.1.2034363.Aidonidis I, Poyatzi A, Stamatiou G, et al. Assessment of local atrial repolarization in a porcine acetylcholine model of atrial flutter and fibrillation. Acta Cardiol. 2009;64(1):59-64. doi:10.2143/AC.64.1.2034363.Wu TJ, Ong JJ, Chang CM, et al. Pulmonary veins and ligament of Marshall as sources of rapid activations in a canine model of sustained atrial fibrillation. Circulation. 2001;103(8):1157-63. doi:10.1161/01.cir.103.8.1157.Wu TJ, Ong JJ, Chang CM, et al. Pulmonary veins and ligament of Marshall as sources of rapid activations in a canine model of sustained atrial fibrillation. Circulation. 2001;103(8):1157-63. doi:10.1161/01.cir.103.8.1157.Valderrábano M, Peterson LE, Swarup V, et al. Effect of catheter ablation with vein of Marshall ethanol infusion vs catheter ablation alone on persistent atrial fibrillation: the VENUS randomized clinical trial. JAMA. 2020;324(16):1620-8. doi:10.1001/jama.2020.16195.Valderrábano M, Peterson LE, Swarup V, et al. Effect of catheter ablation with vein of Marshall ethanol infusion vs catheter ablation alone on persistent atrial fibrillation: the VENUS randomized clinical trial. JAMA. 2020;324(16):1620-8. doi:10.1001/jama.2020.16195.Báez-Escudero JL, Morales PF, Dave AS, et al. Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation. Heart Rhythm. 2012;9(8):1207-15. doi:10.1016/j.hrthm.2012.03.008.Báez-Escudero JL, Morales PF, Dave AS, et al. Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation. Heart Rhythm. 2012;9(8):1207-15. doi:10.1016/j.hrthm.2012.03.008.Yang Z, Tiemuerniyazi X, Xu F, et al. Partial cardiac denervation to prevent postoperative atrial fibrillation after coronary artery bypass grafting: the pCAD-POAF randomized clinical trial. JAMA Cardiol. 2025;10(1):71-7. doi:10.1001/jamacardio.2024.4639.Yang Z, Tiemuerniyazi X, Xu F, et al. Partial cardiac denervation to prevent postoperative atrial fibrillation after coronary artery bypass grafting: the pCAD-POAF randomized clinical trial. JAMA Cardiol. 2025;10(1):71-7. doi:10.1001/jamacardio.2024.4639.Briceño DF, Valderrábano M. Recurrent perimitral flutter due to vein of Marshall epicardial connections bypassing the mitral isthmus: response to ethanol infusion. Circ Arrhythm Electrophysiol. 2014;7(5):988-9. doi:10.1161/CIRCEP.114.001631.Briceño DF, Valderrábano M. Recurrent perimitral flutter due to vein of Marshall epicardial connections bypassing the mitral isthmus: response to ethanol infusion. Circ Arrhythm Electrophysiol. 2014;7(5):988-9. doi:10.1161/CIRCEP.114.001631.Doshi RN, Wu TJ, Yashima M, et al. Relation between ligament of Marshall and adrenergic atrial tachyarrhythmia. Circulation. 1999;100(8):876-83. doi:10.1161/01.cir.100.8.876.Doshi RN, Wu TJ, Yashima M, et al. Relation between ligament of Marshall and adrenergic atrial tachyarrhythmia. Circulation. 1999;100(8):876-83. doi:10.1161/01.cir.100.8.876.Chugh A, Gurm HS, Krishnasamy K, et al. Spectrum of atrial arrhythmias using the ligament of Marshall in patients with atrial fibrillation. Heart Rhythm. 2018;15(1):17-24. doi:10.1016/j.hrthm.2017.07.033.Chugh A, Gurm HS, Krishnasamy K, et al. Spectrum of atrial arrhythmias using the ligament of Marshall in patients with atrial fibrillation. Heart Rhythm. 2018;15(1):17-24. doi:10.1016/j.hrthm.2017.07.033.Гасымова Н.З., Шабанов В.В., Сафонов Н.В. и др. Многоконтактное картирование в лечении различных нарушений ритма сердца. Вестник аритмологии. 2024;31(1):110- 22. doi:10.35336/VA-1297.Gasimova NZ, Shabanov VV, Safonov NV, et al. Multipolar mapping in the management of different arrhythmias. Journal of Arrhythmology. 2024;31(1):110-22. (In Russ.) doi:10.35336/VA-1297.Mlynarski R, Mlynarska A, Golba KS, et al. Vein of Marshall visualization in cardiac computed tomography. Eur Heart J. 2020;41(Suppl_2): ehaa946.0161. doi:10.1093/ehjci/ehaa946.0161.Mlynarski R, Mlynarska A, Golba KS, et al. Vein of Marshall visualization in cardiac computed tomography. Eur Heart J. 2020;41(Suppl_2): ehaa946.0161. doi:10.1093/ehjci/ehaa946.0161.Zhang HD, Ding L, Yu FY, et al. Angiographic assessment of vein of Marshall in atrial fibrillation: implications for identification and cannulation. Heliyon. 2023;9(11):e21266. doi:10.1016/j.heliyon.2023.e21266.Zhang HD, Ding L, Yu FY, et al. Angiographic assessment of vein of Marshall in atrial fibrillation: implications for identification and cannulation. Heliyon. 2023;9(11):e21266. doi:10.1016/j.heliyon.2023.e21266.Hwang C, Fishbein MC, Chen PS. How and when to ablate the ligament of Marshall. Heart Rhythm. 2006;3(12):1505-7. doi:10.1016/j.hrthm.2006.09.014.Hwang C, Fishbein MC, Chen PS. How and when to ablate the ligament of Marshall. Heart Rhythm. 2006;3(12):1505-7. doi:10.1016/j.hrthm.2006.09.014.Liu CM, Lo LW, Lin YJ, et al. Long-term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2019;30:1215-22.Liu CM, Lo LW, Lin YJ, et al. Long-term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2019;30:1215-22.Kamakura T, Derval N, Duchateau J, et al. Vein of Marshall ethanol infusion: feasibility, pitfalls, and complications in over 700 patients. Circ Arrhythm Electrophysiol. 2021;14(8):e010001. doi:10.1161/CIRCEP.121.010001.Kamakura T, Derval N, Duchateau J, et al. Vein of Marshall ethanol infusion: feasibility, pitfalls, and complications in over 700 patients. Circ Arrhythm Electrophysiol. 2021;14(8):e010001. doi:10.1161/CIRCEP.121.010001.

The authors declare that there are no conflicts of interest present.