ligament of Marshall
The Ligament of Marshall (LoM) is a complex of muscle bundles, blood vessels, adipose tissue, fibrous structure, ganglia, and nerves between the left atrial appendage and the left superior pulmonary vein.{{cite journal | vauthors=Corradi D, Callegari S, Macchi E | title=Morphology and pathophysiology of target anatomical sites for ablation procedures in patients with atrial fibrillation: part II: pulmonary veins, caval veins, ganglionated plexi, and ligament of Marshall | journal=International Journal of Cardiology | volume=168 | issue=3 | pages=1769–1778 | year=2016 | doi = 10.1016/j.ijcard.2013.06.141 | pmid=23907042 }}{{cite journal | vauthors=Stavrakis S, Po S | title=Ganglionated Plexi Ablation: Physiology and Clinical Applications | journal=Arrhythmia & Electrophysiology Review | volume=6 | issue=4 | pages=186–190 | year=2017| doi = 10.15420/aer2017.26.1 | pmc=5739885 | pmid=29326833 }} The LoM consists of the Vein of Marshall (VoM), a band of muscle called to Marshall Bundle (MB), and the epicardial ganglionated plexi.
Ligament is fibrous connective tissue between bones, so "ligament" in "Ligament of Marshall" is a misnomer.
Atrial fibrillation
Pulmonary vein isolation has been the mainstay of atrial fibrillation reduction, but in many cases there are other sources of arrhythmia, including the LoM.{{cite journal | vauthors=Rodríguez-Mañero M, Schurmann P, Valderrábano M | title=Ligament and vein of Marshall: A therapeutic opportunity in atrial fibrillation | journal=Heart Rhythm | volume=13 | issue=2 | pages=593–601 | year=2016| doi = 10.1016/j.hrthm.2015.10.018 | pmc=4796610 | pmid=26576705 }} Use of ethanol through the VoM has been shown to be an effective way to reduce atrial fibrillation.{{cite journal | vauthors=Li F, Sun J, Wang R | title=The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis | journal=Frontiers in Cardiovascular Medicine | volume=9 | pages=871654 | year=2022 | doi = 10.3389/fcvm.2022.871654 | doi-access=free | pmc=9098965 | pmid=35571170 }}
Discovery
The LoM was discovered in 1850 by British surgeon John Marshall, which was later named in his honor.