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Volume 14
Issue 23
10.3390/jcm14238422
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Review

The Marshall Complex in the Human Heart: Embryology, Microanatomy, Autonomic Features and Clinical Implications for Atrial Fibrillation—A State-of-the-Art Narrative Review

by
Wojciech Bartosz Dutka
1,2,*,
Adam Bochenek
1,
Tomasz Lepich
1,
Marcin Malinowski
2 and
Grzegorz Bajor
1,3
1
Department of Human Anatomy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-762 Katowice, Poland
2
Department of Cardiac Surgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-007 Katowice, Poland
3
Department of Anatomy, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(23), 8422; https://doi.org/10.3390/jcm14238422 (registering DOI)
Submission received: 30 October 2025 / Revised: 21 November 2025 / Accepted: 25 November 2025 / Published: 27 November 2025
(This article belongs to the Section Cardiology)
Versions Notes

Abstract

The vein and ligament of Marshall (VOM and LOM) are embryological remnants that have gained increasing recognition due to their anatomical complexity, arrhythmogenic potential, and relevance during catheter ablation and structural heart interventions. This review summarizes current evidence on their embryology, morphology, anatomical variability, imaging characteristics, and clinical implications. A structured literature search across PubMed, Embase, and Scopus identified anatomical, histological, electrophysiological, and interventional studies. The VOM is present in most hearts, but its topographic variants and ostial positions show substantial interindividual diversity. The LOM displays a segmental architecture with distinct muscular and fibrotic components that interface with the atrial myocardium and the coronary sinus, providing a substrate for atrial fibrillation. Advances in cardiac imaging have improved delineation of the VOM–LOM region, enhancing pre-procedural assessment and guidance for ethanol infusion and ablation strategies. Recognition of the variability and functional significance of these structures is essential for optimizing procedural outcomes and avoiding complications. Taken together, the VOM and LOM represent key atrial venous remnants whose detailed characterization contributes to a deeper understanding of atrial arrhythmogenesis and contemporary interventional electrophysiology.
Keywords: vein of Marshall; oblique vein of the left atrium; ligament of Marshall; left superior vena cava; atrial fibrillation; cardiac anatomy; electrophysiology; ablation; Marshall bundle vein of Marshall; oblique vein of the left atrium; ligament of Marshall; left superior vena cava; atrial fibrillation; cardiac anatomy; electrophysiology; ablation; Marshall bundle

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MDPI and ACS Style

Dutka, W.B.; Bochenek, A.; Lepich, T.; Malinowski, M.; Bajor, G. The Marshall Complex in the Human Heart: Embryology, Microanatomy, Autonomic Features and Clinical Implications for Atrial Fibrillation—A State-of-the-Art Narrative Review. J. Clin. Med. 2025, 14, 8422. https://doi.org/10.3390/jcm14238422

AMA Style

Dutka WB, Bochenek A, Lepich T, Malinowski M, Bajor G. The Marshall Complex in the Human Heart: Embryology, Microanatomy, Autonomic Features and Clinical Implications for Atrial Fibrillation—A State-of-the-Art Narrative Review. Journal of Clinical Medicine. 2025; 14(23):8422. https://doi.org/10.3390/jcm14238422

Chicago/Turabian Style

Dutka, Wojciech Bartosz, Adam Bochenek, Tomasz Lepich, Marcin Malinowski, and Grzegorz Bajor. 2025. "The Marshall Complex in the Human Heart: Embryology, Microanatomy, Autonomic Features and Clinical Implications for Atrial Fibrillation—A State-of-the-Art Narrative Review" Journal of Clinical Medicine 14, no. 23: 8422. https://doi.org/10.3390/jcm14238422

APA Style

Dutka, W. B., Bochenek, A., Lepich, T., Malinowski, M., & Bajor, G. (2025). The Marshall Complex in the Human Heart: Embryology, Microanatomy, Autonomic Features and Clinical Implications for Atrial Fibrillation—A State-of-the-Art Narrative Review. Journal of Clinical Medicine, 14(23), 8422. https://doi.org/10.3390/jcm14238422

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