Dimension and Related Anatomical Distance of Koch's Triangle in Patients with Atrioventricular Nodal Reentrant Tachycardia

Ueng, Kwo‐Chang; Chen, Shih‐Ann; Chiang, Chern‐En; Tai, Ching‐Tai; Lee, Shih‐Huang; Chiou, Chuen-Wong; Wen, Zu Chi; Tseng, Chi-Jen; Chen, Yi Jen; Yu, Wen‐Chung; Chen, Chung-Yin; Chang, Mau‐Song

doi:10.1111/j.1540-8167.1996.tb00477.x

Cited by 57 publications

(37 citation statements)

References 13 publications

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“…Moreover, the size of the recording range of bipolar and unipolar electrograms may be too large for the dimension of KT, although several studies on mapping of KT have been made using a similar size of recording electrodes. 2,7,17,33 Therefore, further studies using smaller sizes of the recording electrodes may be useful to confirm the results of the present study.…”

Section: Study Limitationssupporting

confidence: 71%

“…T he Koch triangle (KT) is an important anatomic area of the right atrium (RA) where the compact atrioventricular (AV) node and the slow and fast pathways are located 1,2 ; therefore, it is a crucial area for initiation, maintenance, and ablation of AV nodal reentrant tachycardia (AVNRT). Several authors investigated the propagation of the sinus impulse into the KT, obtaining different results.…”

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confidence: 99%

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Propagation of the Sinus Impulse Into the Koch Triangle and Localization, Timing, and Origin of the Multicomponent Potentials Recorded in This Area

Pandozi

Ficili

Galeazzi

et al. 2011

Circ: Arrhythmia and Electrophysiology

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Background-The presence of a conduction block at the level of the Koch triangle (KT) and the origin of the multicomponent potentials inside this area are controversial issues. We investigated the propagation of the sinus impulse into the KT and the characteristics of multicomponent potentials recorded in that area in patients with and without atrioventricular nodal reentrant tachycardia (AVNRT). Methods and Results-Thirty-two patients (16 with AVNRT, 16 without AVNRT) underwent a sinus rhythm electroanatomic mapping of the right atrium (RA). Conduction velocities in the RA and in the KT were evaluated quantitatively on activation maps and qualitatively on isochronal and propagation maps. The presence, location, and timing of different types of multicomponent potentials were evaluated. A mean of 149Ϯ44 points were sampled in the RA, whereas a mean of 79Ϯ21 points were collected inside the KT. Propagation block at the level of crista terminalis was not found in any patient, whereas slow conduction inside the KT was found in all (

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Section: Study Limitationssupporting

confidence: 71%

mentioning

confidence: 99%

Propagation of the Sinus Impulse Into the Koch Triangle and Localization, Timing, and Origin of the Multicomponent Potentials Recorded in This Area

Pandozi

Ficili

Galeazzi

et al. 2011

Circ: Arrhythmia and Electrophysiology

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“…12,13 Cabrera et al 11 recently reported on angiographic measurements in 23 patients and found a mean isthmus width of 37Ϯ8 mm. Also, their values for the relative length of the tricuspid vestibule and IVC recess are close to ours.…”

Section: Discussionmentioning

confidence: 99%

Right Atrial Angiographic Evaluation of the Posterior Isthmus

et al. 2000

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Background-Gaining anatomic information about the posterior isthmus is not generally part of flutter ablation procedures. We postulated that right atrial (RA) angiography could rationalize the ablation approach by revealing the conformation of the isthmus. Methods and Results-In 100 consecutive patients, biplane RA angiography was performed before ablation to guide catheter contact with the isthmus along its length. Angiography showed a wide variation in the width of the isthmus (17 to 54 mm; 31.3Ϯ7.9), its angle with the inferior vena cava in the right anterior oblique projection (68°to 114°; 90.3Ϯ9.0°), and its lateral position relative to the inferior vena cava in the left anterior oblique projection. A deep sub-Eustachian recess was revealed in 47%, with a mean depth of 4.3Ϯ2.1 mm (1.5 to 9.4). A Eustachian valve was visualized in 24%. Ablation resulted in bidirectional conduction block (which could be transient) in all, with a median of 2 dragging radiofrequency (RF) applications (2.3Ϯ2.5 RF applications; 57°C, Յ99 seconds each). Permanent block was achieved in 99%, with a median of 3 RF applications (3.4Ϯ3.0). The presence of a Eustachian valve or concave isthmus was associated with statistically more RF applications; the same trend was seen for patients with deep pouches. The number of RF applications decreased statistically throughout the study, indicating a learning curve. No patient had a recurrence after a follow-up of 13Ϯ11 months. Conclusions-Right atrial angiography reveals a highly variable isthmus anatomy, often showing particular configurations that can make ablation more laborious. Rational adaptation of the ablation approach to these anatomic findings may contribute to successful ablation.

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“…Our previous report showed that the length between the distal Hisian site and coronary sinus ostium was negatively correlated with age. 20 The anatomical remodeling with aging might be related to the functional change in the AV node. It remains unclear if patients aged 20-40 years old in the present study shared similar mechanisms of AVN remodeling as previously reported.…”

Section: Paradoxical Changes In Av Nodal Electrophysiological Charactmentioning

confidence: 99%

Paradoxical Aging Changes of the Atrioventricular Nodal Properties in Patients With Atrioventricular Nodal Re-Entrant Tachycardia

Tseng

Tsai

et al. 2011

Circ J

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Background: This study aimed to investigate the impact of aging on electrophysiological characteristics in patients with atrioventricular nodal re-entrant tachycardia (AVNRT). Methods and Results:The 2,111 patients who underwent an electrophysiological study and radiofrequency (RF) catheter ablation of AVNRT were enrolled. The patients were divided into 4 groups according to age (group 1: <20 years; group 2: 20-39 years; group 3: 40-59 years; and group 4: ≥60 years). The gender distribution differed with age. The atrio-Hisian interval, and effective refractory periods (ERP) of the right atrium, ventricle, antegrade slow pathway, retrograde slow pathway and fast pathway, and tachycardia cycle length all increased with age. However, a paradoxical change in the fast pathway ERP was noted. The fast pathway ERP was significantly longer in group 2 than in other groups, and was associated with the largest tachycardia window. The response to catecholamines was similar between different age groups. Procedure time, radiation time, and complications did not differ. However, the number of RF impulses was higher in group 2 compared with other groups (7.6±9.3, P=0.04), which might imply a differing complexity during the ablation. Conclusions:Paradoxical aging changes of AVN electrophysiological characteristics were associated with a different atrioventricular nodal conduction property and the number of RF impulses. (Circ J 2011; 75: 1581 -1584

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Dimension and Related Anatomical Distance of Koch's Triangle in Patients with Atrioventricular Nodal Reentrant Tachycardia

Cited by 57 publications

References 13 publications

Propagation of the Sinus Impulse Into the Koch Triangle and Localization, Timing, and Origin of the Multicomponent Potentials Recorded in This Area

Propagation of the Sinus Impulse Into the Koch Triangle and Localization, Timing, and Origin of the Multicomponent Potentials Recorded in This Area

Right Atrial Angiographic Evaluation of the Posterior Isthmus

Paradoxical Aging Changes of the Atrioventricular Nodal Properties in Patients With Atrioventricular Nodal Re-Entrant Tachycardia

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