LONDON, UNITED KINGDOM. The vein of Marshall (VOM) is part of the heart's venous system and drains into the coronary sinus. It is located on the back wall of the left atrium and may exhibit focal electrical activity than can initiate atrial fibrillation (AF). The focal points can be eliminated by catheter ablation or, in some cases, by ethanol infusions (vagal denervation) into the vein.

A team of cardiologists at Royal Brompton Hospital now report a case where injection of hematopoietic stem cells into the VOM eliminated long-standing persistent AF. The patient was an 84-year-old man with a 4-year history of permanent AF. He had previously undergone aortic and tricuspid valve surgery and had also had a coronary bypass operation. His left atrium was grossly enlarged with a diameter of 69 mm (6.9 cm).

Stem cells were harvested from his own bone marrow and after suitable preparation injected directly into the VOM through the coronary sinus. Twenty days following the procedure, the patient returned to normal sinus rhythm and has remained AF-free for 15 months. The research team calls for further studies to determine whether stem cells delivered to the VOM have a role in the treatment of AF, either through transdifferentiation (conversion of hematopoietic stem cells into heart cells) or by vagal denervation (ablation of ganglionated plexi). See Stem Cells 101 for more on stem cells.
Lyne, JC, et al. Stem cell infusion into the vein of Marshall. Europace, Vol. 13, March 2011, p. 438

Editor's comment: This fascinating case history adds to the accumulating evidence that stem cell therapy may, in the not too distant future, emerge as a viable alternative to drug therapy, and catheter-based and surgical procedures for the elimination of AF.