High-resolution mapping of the triangle of Koch: Spatial heterogeneity of fast pathway atrionodal connections

Retrograde fast pathway cryoablation inside the coronary sinus for slow‐fast atrioventricular nodal reentrant tachycardia in a patient with persistent left superior vena cava

“…2 AV nodal pathways, including fast pathways, slow pathways with rightward and leftward inferior extensions, inferolateral left atrial slow pathways, and superior slow pathways, are mainly categorized by the anatomical position of the earliest atrial activation site [3][4][5] ; however, applying this anatomical categorization in patients with a PLSVC can be difficult due to deformation of the triangle of Koch. Chua et al 6 reported a variant of the retrograde fast pathway location, and some cases had the retrograde fast pathway attached to the posteroseptal right atrium. In our case, the earliest atrial activation site of the VA conduction was inside the CS, specifically the roof of the enlarged CS, but the VA interval was very short and equivalent to the fast pathway.…”

The Maze Procedure and Postoperative Pacemakers

“…Both the AV node and the proximal portion of the His bundle are located within the atrial septum ( Fig 2). Viewed from the right side of the septum, they are located within in an anatomic region of the atrial septum called the triangle of Koch [24,25]. This triangle is bordered superiorly by the tendon of Todaro, which can be identified visually in an open RA by placing posterior-inferior Abbreviations and Acronyms AF = atrial fibrillation AV = atrioventricular CTSN = Cardiothoracic Surgical Trials Network LA = left atrium PAF = paroxysmal atrial fibrillation RA = right atrium SA = sinoatrial SVC = superior vena cava traction on the coronary sinus os.…”

“…The first maze procedure for AF was performed on September 25,1987, and all iterations during the subsequent 3 decades have included lesions in the entire atrial continuum, namely, in both the right and left atria [1][2][3][4][5][6][7][8]. It has been suggested that the RA lesions of maze procedures damage the heart's specialized conduction system and cause patients to need more permanent pacemakers postoperatively while providing little therapeutic advantage over LA lesions alone [9][10][11].…”

A Novel Concept in AVNRT

“…However, when EPS indicates several earliest sites and/or conduction properties, a 3-dimensional mapping system could help us to identify each of the earliest activation sites in the atrium. 8) A detailed mechanism of AVNRT which could provide a link between the electrophysiological and anatomical findings has not been elucidated. In recent years, as the accuracy of 3-dimensional mapping systems has improved, detailed high resolution mapping has become possible and could help us to clarify the mechanism of any type of AVNRT.…”