Regional Cardiac Remodeling Signatures Across Atria and Ventricles Revealed by Vein of Marshall and Anterior Interventricular Vein Sampling

Summary

Collecting the blood in the vein of Marshall (VOM) is a feasible and highly reproducible method for real-time detection of human atrial biochemical profiles. VOM-derived blood provides a unique window for studying atrial remodeling, which may help provide a platform for future mechanism research and the discovery of biomarkers.

Abstract

The incidence rate of atrial fibrillation is increasing year by year, which is characterized by time progression, but its mechanism is unknown. Vein of Marshall (VOM), also known as the left atrial oblique vein, plays a crucial role in collecting venous return from atrial tissue. VOM originates from the posterior wall of the left atrium and is closely related to structures such as the left atrial appendage and pulmonary vein. VOM plays an important role in the occurrence and maintenance of atrial fibrillation, but there have been no other reports on its role in atrial fibrillation-related diseases. In this research, the authors innovatively used over-the-wire (OTW) balloons to collect blood samples from the VOM patients before atrial fibrillation ablation surgery for biochemical analysis. This study measured a recognized biomarker associated with the onset of atrial fibrillation: atrial natriuretic peptide (ANP), a biomarker of atrial stretching and structural remodeling, a biologically active natriuretic peptide that plays an important role in atrial fibrillation. Compared with samples from the anterior interventricular vein (AIV) and coronary sinus (CS), ANP concentration was significantly upregulated in VOM blood, indicating that VOM blood better captures atrial-specific biochemical signals. This research found that VOM blood provides a good representation of the microenvironment associated with atrial fibrillation, providing scientific evidence for the search for biomarkers and therapeutic targets for the future.

Introduction

Vein of Marshall (VOM), also known as the left atrial oblique vein, plays a crucial role in collecting venous return from atrial tissue. VOM originates from the posterior wall of the left atrium and is closely related to structures such as the left atrial appendage and pulmonary vein¹. Its unique anatomical location and venous network structure enable direct or indirect electrical connections and fluid interactions with the left atrium and pulmonary veins^2,3. VOM plays an important role in the occurrence and maintenance of atrial fibrillation, but its role in atrial fibrillation-related....

Protocol

The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Xinhua Hospital (XHEC-C-2023-128-2). All items required in this protocol are listed in the Table of Materials.

CAUTION: Avoid forceful guidewire advancement, deep catheter engagement, and high-pressure balloon inflation during the procedure. The balloon should be inflated gently and only to the minimum pressure necessary for catheter stabilization and partial venous occlusion. Continuous fluoroscopic monitoring of the guidewire, catheter tip, balloon position, and contrast flow is essential throug....

Results

The method of this study adopts a perspective-guided OTW balloon microcatheter strategy, which can achieve partitioned collection of atrial- and ventricular-specific reflux venous blood during catheter ablation of atrial fibrillation: identification and selective entry into the Marshall vein (VOM) and the anterior interventricular vein (AIV) through coronary sinus angiography. Simultaneously, control samples were obtained from the main coronary sinus (CS) and left atrial cavity (LA, intracavitary reference) (

Discussion

This study proposes and validates a new blood sampling approach and method: collecting blood samples from the Marshall vein (VOM) and the anterior interventricular vein (AIV) under catheterization. Due to the lack of routine methods for obtaining atrial tissue samples in clinical practice, the understanding of the mechanisms of atrial fibrillation (AF) and atrial remodeling is limited. Marshall vein is located within the mitral isthmus, critical for perimitral atrial tachycardia¹⁰. The vein of Mar.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
8F venous sheath	TERUMO	RS A80K10SQ	8F venous introducer sheath; used to establish venous access and introduce the CS sheath or guiding catheter during VOM and AIV sampling.
BMW guidewire	Abbott	1001780-HC	0.014-inch hydrophilic coronary guidewire; 190 cm length; 3 cm radiopaque tip
contrast agent	Visipaque	86978446001021	Nonionic iso-osmolar iodinated contrast medium; used for CS venography and selective visualization of the VOM and AIV during catheter positioning.
CS sheath	Synaptic	D6010282092DNRT	Coronary sinus guiding sheath; used to access the coronary sinus and provide support for selective catheterization of the VOM and AIV.
EDTA collection tubes	Lianke Bio	PL18-703C-7	Pre-cooled EDTA blood collection tube; used for plasma collection and prevention of coagulation during VOM, AIV, CS, and LA blood sampling
guidewire	TERUMO	TW-AS418FA	Hydrophilic angiographic guidewire; used to assist selective catheter positioning and vessel navigation during CS venography and VOM/AIV cannulation.
Judkins catheter	Medtronic	LA6JR40	Judkins right catheter; used to assist retrograde exploration of the proximal coronary sinus and selective visualization of the VOM ostium.
Microcatheter	TERUMO	NC-F863A	used to provide guidewire and assist selective advancement into the VOM or AIV during regional venous blood sampling
OTW balloon catheter	DK MEDTECH	OIB-2015	1.5–2.5 mm over-the-wire coronary balloon catheter; used for superselective VOM/AIV cannulation, temporary low-pressure occlusion, and regional venous blood collection under fluoroscopic guidance.
protease inhibitors	beyotime	P1005	The protease inhibitor cocktail for general use (100X) from Biyun Tian is a universal mixture of protease inhibitors used for cell or tissue protein extraction, including 200 mM AEBSF, 30 μM Aprotinin, 13 mM Bestatin, 1.4 mM E64, and 1 mM Leupeptin in DMSO
Refrigerated centrifuge	Eppendorf	5811000015	used to centrifuge EDTA blood samples at 4 °C for plasma separation