Anatomic Assessment of Variations in Myocardial Approaches to the Atrioventricular Node

Abstract

The myocardial approaches including the transitional cell zone toward the AV node are variable in normal hearts. The location and size of the CS can affect the myocardial arrangements and the area of transitional cells around the AV node.

Relationship between the atrial‐activation pattern around the triangle of Koch and successful ablation sites in slow‐fast atrioventricular nodal reentrant tachycardia

“…However, ablation at sites with a larger AV ratio around the ToK was at risk of advanced AV block, as several patients could have a compact AV node inside the posterior ToK as shown by our present analyses. It is well known that there is electro‐anatomical variance inside the ToK 20,21 . In all, four patients with a transient AV block exhibited coincidence between the AV block sites and the area with fractionated and large atrial signals highlighted by complex activation inside the ToK.…”

“…However, we have to keep in mind the risk of AV block, which occurs in some patients whose earliest atrial activation site over the retrograde AV nodal fast pathway lies inside the posterior ToK 20 . Individual anatomical variations around Koch's triangle may make it difficult to identify the location of the compact AV node during the procedure 21 . The representative cases had a transient prolongation of the PQ interval during ablation inside the Lumipoint‐highlighted area in the posterior site of the ToK, as shown in Figure 4.…”

“…20 Individual anatomical variations around Koch's triangle may make it difficult to identify the location of the compact AV node during the procedure. 21 The representative cases had a transient prolongation of the PQ interval during ablation inside the Lumipoint-highlighted area in the posterior site of the ToK, as shown in Figure 4. Successful SP modification ablation was outside the Lumipoint-highlighted area.…”

“…It is well known that there is electro-anatomical variance inside the ToK. 20,21 In all, four patients with a transient AV block exhibited coincidence between the AV block sites and the area with fraction- Our results could support that (i) the AV ratio of the sites of SP modification ablation could be used as a parameter of risk of AV block, and (ii) the fractionated atrial potential consisting of a far-field dull potential and a near-field spiky potential could be useful as a parameter of the efficacy of SP modification.…”

A rat model of complete atrioventricular block recapitulates clinical indices of bradycardia and provides a platform to test disease-modifying therapies

“…The epicardial fat pad served as the anatomical landmark for the AVN region in all those models. However, because the location of the AVN can vary significantly from animal to animal 34,35 , this anatomical landmark alone resulted in limited success. We first attempted alcohol ablation of the AVN by direct, intramyocardial delivery of 70% ethanol to the AVN region 20 .…”